Validation of a scoring algorithm for non-overt
disseminated intravascular coagulation (
DIC) proposed by the International Society on
Thrombosis and Haemostasis (ISTH) is still incomplete. It was the objective of this study to assess the impact of including AT to non-overt
DIC scoring on the predictability for intensive care unit (ICU) death and the later development of overt-
DIC defined by the Japanese Ministry of Health and Welfare (JMHW) or the ISTH. We performed a retrospective observational study conducted in 364 patients in
critical care. Coagulation parameters obtained daily for
DIC screening were utilised for scoring. There were 194 and 196 patients scored as positive non-overt
DIC with and without AT, respectively; diagnostic agreement between the two was 78%. As compared with patients without non-overt
DIC, these non-overt
DIC patients had significantly higher mortality. In 37 ICU non-survivors, positive non-overt
DIC scoring with AT preceded ICU death by a median of 6.8 days, which was significantly earlier as compared with a median of 5.4 days for non-overt
DIC without AT (p = 0.022). In patients who developed overt-
DIC after admission, the time period from positive non-overt
DIC to positive overt-
DIC was significantly longer when AT was utilised (overt-
DIC ISTH; 1.3 days vs. 0.1 days, p = 0.004, overt-
DIC JMHW; 2.5 days vs. 2.0 days, p = 0.04, with AT vs. without AT, respectively). Non-overt
DIC scoring predicted a high risk of death in
critically ill patients. When information on AT levels was included, non-overt
DIC scoring was found to predict development of overt-
DIC significantly earlier than non-overt
DIC scoring without AT.