Evaluation of hyperketonemia risk period and screening protocols for early-lactation dairy cows.

The objectives of this study were to describe the onset of hyperketonemia, the number of positive hyperketonemia test results, and the duration of the longest hyperketonemic period during the first 42 d in milk (DIM) in dairy cows. Furthermore, we set out to evaluate test characteristics of single and repeated measurements of ß-hydroxybutyric acid (BHBA) during this period to diagnose hyperketonemia. Using an electronic handheld meter, 252 cows from 3 farms were tested twice weekly for hyperketonemia (blood BHBA ≥1.2 mmol/L) during the first 42 DIM, resulting in 12 test results per cow (i.e., in lactation wk 0.5 to 6). Prevalence and incidence of hyperketonemia were calculated for the 12 examination days and the 42-d period, respectively. Test characteristics for the diagnosis of hyperketonemia were calculated for 4 different testing scenarios (testing all cows 1, 2, 3, or 6 times during the first 42 DIM) and 2 different gold-standard definitions (BHBA ≥1.2 mmol/L at least once during the observation period or BHBA ≥1.2 mmol/L at least twice during the observation period). Mean prevalence of hyperketonemia was 11.8%, ranging from 9.6% in lactation wk 0.5 and 2.0 to 14.6% in lactation wk 5.5. In total, 134 cows (53.2%) had at least 1 positive hyperketonemia test result during the whole 42-d period. Of these cows, 46.3% had only 1 positive result. The median first positive hyperketonemia test result was in lactation wk 2.0 [interquartile range (IQR) 1.0-3.5]. Median frequency of positive test results in cows affected by hyperketonemia was 2 positive test results (IQR 1-3). Median duration of the longest hyperketonemic period per cow affected was 1 examination interval (3-4 d; IQR 1-2). Considering a minimum of 1 positive hyperketonemia test result during the first 42 DIM as the gold standard, sensitivity of a single BHBA measurement during this period to diagnose hyperketonemia was 21%. A weekly testing protocol had a sensitivity of 72%. Specificity was 100% in both cases. Considering a minimum of 2 positive hyperketonemia test results as the gold standard, sensitivity and specificity of a single BHBA measurement during the first 42 DIM were 33 and 97%, respectively. A weekly testing protocol provided sensitivity and specificity of 91 and 83%, respectively. We conclude that the risk period for hyperketonemia lasts at least until lactation wk 6, which should be considered when planning hyperketonemia screening programs. Test characteristics of screening protocols depend on testing frequency.

[Evaluation of a new electronic handheld meter for measurement of ß-hydroxybutyric acid in dairy cows]. / Evaluation eines neuen elektronischen Handmessgeräts zur Messung von ß-Hydroxybutyrat bei Milchkühen.

OBJECTIVE: Subclinical ketosis (SCK), an important disease in lactating dairy cows, is defined as the presence of elevated concentrations of circulating ketone bodies without the development of clinical signs. Therefore, diagnostic methods are limited to the detection of the concentrations of ketone bodies in different body fluids. The objective of this study was to evaluate a recently developed electronic hand- held meter (NovaVet) for the determination of ß-hydroxybutyric acid (BHB) in the blood of dairy cows. MATERIAL AND METHODS: A total of 155 lactating dairy cows were included in the trial. Blood samples were taken from each cow and analyzed using the BHB meter. The obtained concentrations were compared to the results determined by a commercial laboratory. The Spearman's rank correlation coefficient was determined between the two methods. A Wilcoxon test was performed and a Bland-Altman plot was generated. Test characteristics (sensitivity, specificity, positive and negative predictive value) for established BHB cut points for the diagnosis of SCK were calculated using receiver operating characteristic (ROC) analysis. RESULTS: The two methods were highly correlated (rs = 0.87; p < 0.05). A difference (median 0.0 mmol/l; interquartile range [IQR] -0.1 to 0.2 mmol/l; p < 0.05) was found between BHB concentrations determined using the BHB meter (median 1.0 mmol/l; IQR 0.7-1.3 mmol/l) and by the laboratory (median 0.9 mmol/l; IQR 0.7-1.1 mmol/l). Using a cut point of 1.2 mmol/l, sensitivity and specificity of the BHB meter were 97% and 82%, respectively. CONCLUSION AND CLINICAL RELEVANCE: There was a good agreement between BHB concentrations determined using the BHB meter and the laboratory. Furthermore, the BHB meter displayed good test characteristics. The specificity of 82% results in a number of false-positive results. However, this new device can be recommended for the detection of SCK in cows under practical conditions.

Effects of time and sampling location on concentrations of ß-hydroxybutyric acid in dairy cows.

Two trials were conducted to examine factors potentially influencing the measurement of blood ß-hydroxybutyric acid (BHBA) in dairy cows. The objective of the first trial was to study effects of sampling time on BHBA concentration in continuously fed dairy cows. Furthermore, we determined test characteristics of a single BHBA measurement at a random time of the day to diagnose subclinical ketosis considering commonly used cut-points (1.2 and 1.4 mmol/L). Finally, we set out to evaluate if test characteristics could be enhanced by repeating measurements after different time intervals. During 4 herd visits, a total of 128 cows (8 to 28 d in milk) fed 10 times daily were screened at 0900 h and preselected by BHBA concentration. Blood samples were drawn from the tail vessels and BHBA concentrations were measured using an electronic BHBA meter (Precision Xceed, Abbott Diabetes Care Ltd., Witney, UK). Cows with BHBA concentrations ≥0.8 mmol/L at this time were enrolled in the trial (n=92). Subsequent BHBA measurements took place every 3h for a total of 8 measurements during 24 h. The effect of sampling time on BHBA concentrations was tested in a repeated-measures ANOVA repeating sampling time. Sampling time did not affect BHBA concentrations in continuously fed dairy cows. Defining the average daily BHBA concentration calculated from the 8 measurements as the gold standard, a single measurement at a random time of the day to diagnose subclinical ketosis had a sensitivity of 0.90 or 0.89 at the 2 BHBA cut-points (1.2 and 1.4 mmol/L). Specificity was 0.88 or 0.90 using the same cut-points. Repeating measurements after different time intervals improved test characteristics only slightly. In the second experiment, we compared BHBA concentrations of samples drawn from 3 different blood sampling locations (tail vessels, jugular vein, and mammary vein) of 116 lactating dairy cows. Concentrations of BHBA differed in samples from the 3 sampling locations. Mean BHBA concentration was 0.3 mmol/L lower when measured in the mammary vein compared with the jugular vein and 0.4 mmol/L lower in the mammary vein compared with the tail vessels. We conclude that to measure BHBA, blood samples of continuously fed dairy cows can be drawn at any time of the day. A single measurement provides very good test characteristics for on-farm conditions. Blood samples for BHBA measurement should be drawn from the jugular vein or tail vessels; the mammary vein should not be used for this purpose.