Preoperative cow-side lactatemia measurement predicts negative outcome in Holstein dairy cattle with right abomasal disorders
Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, C.P. 5000, St-Hyacinthe, Québec, J2S 7C6, Canada. Electronic address: .Journal of Dairy Science (Impact Factor: 2.57). 10/2013; 97(1). DOI: 10.3168/jds.2013-6898
The objectives of the current study were (1) to determine the gain in prognostic accuracy of preoperative l-lactate concentration (LAC) measured on farm on cows with right displaced abomasum (RDA) or abomasal volvulus (AV) for predicting negative outcome; and (2) to suggest clinically relevant thresholds for such use. A cohort of 102 cows with on-farm surgical diagnostic of RDA or AV was obtained from June 2009 through December 2011. Blood was drawn from coccygeal vessels before surgery and plasma LAC was immediately measured by using a portable clinical analyzer. Dairy producers were interviewed by phone 30 d following surgery and the outcome was determined: a positive outcome if the owner was satisfied of the overall evolution 30 d postoperatively, and a negative outcome if the cow was culled, died, or if the owner reported being unsatisfied 30 d postoperatively. The area under the curve of the receiver operating characteristic curve for LAC was 0.92 and was significantly greater than the area under the curve of the receiver operating characteristic curve of heart rate (HR; 0.77), indicating that LAC, in general, performed better than HR to predict a negative outcome. Furthermore, the ability to predict a negative outcome was significantly improved when LAC measurement was considered in addition to the already available HR data (area under the curve: 0.93 and 95% confidence interval: 0.87, 0.99). Important inflection points of the misclassification cost term function were noted at thresholds of 2 and 6 mmol/L, suggesting the potential utility of these cut-points. The 2 and 6 mmol/L thresholds had a sensitivity, specificity, positive predictive value, and negative predictive value for predicting a negative outcome of 76.2, 82.7, 53.3, and 93.1%, and of 28.6, 97.5, 75, and 84%, respectively. In terms of clinical interpretation, LAC ≤2 mmol/L appeared to be a good indicator of positive outcome and could be used to support a surgical treatment decision. The treatment decision for cows with LAC between 2 and 6 mmol/L, however, would depend on the economic context and the owner's attitude to risk in regard to potential return on its investment. Finally, performing a surgical correction on commercial cows with RDA or AV and a LAC ≥6 mmol/L appeared to be unjustified and these animals should be culled based on their high probability of negative outcome.
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- "In the United States alone, annual losses were calculated to be $220 million (Geishauser et al., 1996). Nearly 90% of DA cases are diagnosed during the transition period—2 wk before until 4 wk after parturition—and between 12 and 65% of these cows die or are culled within 60 d after surgical correction (Shaver, 1997; Sterner et al., 2008; Boulay et al., 2014). Plasma NEFA concentrations >0.72 mEq/L during the first week after parturition are considered a risk predictor for DA (Ospina et al., 2010; Seifi et al., 2011). "
ABSTRACT: High concentrations of plasma nonesterified fatty acids (NEFA), a direct measure of lipolysis, are considered a risk factor for displaced abomasum (DA) and other clinical diseases. In nonruminants, uncontrolled lipolysis is commonly associated with adipose tissue macrophage (ATM) infiltration. In dairy cows, recent studies report ATM infiltration in specific adipose depots during the first week of lactation. Depending on their phenotype, ATM can be broadly classified as classically activated (M1) or alternatively activated (M2). The M1 ATM are considered pro-inflammatory, whereas M2 ATM enhance inflammation resolution. Currently, it is not known whether multiparous transition cows with DA have increased ATM infiltration, and the predominant phenotype of these mononuclear cells remains unclear. The objective of this study was to characterize ATM infiltration into different adipose tissue depots in transition cows with DA (days in milk = 7.8 ± 4.6 d; body condition score = 2.95 ± 0.10; n = 6). Serum samples and biopsies from omental (OM) and subcutaneous (SC) fat depots were obtained during corrective surgery for DA. In an effort to compare ATM infiltration in DA cows with that of healthy cows in anabolic state (AS), adipose biopsies and blood samples were collected from nonlactating, nongestating dairy cows at the time of slaughter (body condition score = 3.75 ± 0.12; n = 6). Adipose tissues were digested and cells from the stromal vascular fraction (SVF) were analyzed using flow cytometry to establish cell surface expression of specific macrophage markers including CD14, CD11c, CD163, and CD172a. Tissue sections were analyzed by immunohistochemistry to assess ATM localization. Cows with DA were ketotic and had plasma NEFA above 1.0 mEq/L. The same group of cows had significant infiltration of ATM in OM characterized by increased numbers of SVF cells expressing CD14 and CD172a. At the same time, expression of CD11c, and CD163 was significantly higher in SVF from OM and SC of DA cows compared with those from AS animals. Expression of M1 macrophage inflammatory phenotype-related genes CCL2, IL6, and TNFα in SVF from cows with DA was significantly higher than that in healthy cows (AS). Significant populations of ATM in OM and SC depots of cows with DA were localized in multiple cellular aggregates that included multinucleated cells. In contrast, ATM in AS cows were fewer and randomly localized in both SC and OM. Together, these results indicate that infiltration of classically activated ATM is a concurrent finding in DA cases and may be associated with metabolic stress around parturition contributing to the pro-inflammatory status of transition dairy cows. Future studies are needed to establish whether ATM infiltration is more pronounced in cows with DA compared with healthy dairy cows at the same lactation stage and if this increased mononuclear immune cell trafficking has any pathophysiological significance. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.
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ABSTRACT: Background Blood L-lactate concentration (LAC) can be used for various diagnostic purposes in cattle. As multiple handheld analyzers for LAC exist, it is important to validate their use in cattle in comparison with reference laboratory blood analyzers.Objectives The objectives of this study were to validate the handheld Lactate Pro meter (LacP) including reproducibility, and compare the measurements with the StatProfile (StatP) as a gold standard. In addition, diagnostic sensitivity and specificity, and the impact of HCT on LAC measured by both analyzers were assessed.MethodsA cohort of 64 cattle with acute medical and surgical conditions was studied. Whole blood samples in heparin lithium tubes were analyzed upon arrival with both StatP and LacP. Twenty-three samples were immediately retested to assess intra-assay coefficient of variation (CV). The HCT values were also recorded.ResultsThe LAC using LacP was highly correlated with the StatP (r = 0.9736 [95% confidence interval [CI]: 0.9562–0.9841]). The LacP underestimated LAC (mean difference:−0.9 mmol/L, 95% CI:−3.1 mmol/L to 1.3 mmol/L). The intra-assay CV was excellent (4.77%). No significant correlation was observed between LacP or StatP and HCT (P = .39 and .09, respectively). Sensitivity and specificity for LacP were 91.7% (95% CI: 76.4–97.8%) and 100% (83.4–100%, cutoff of 4 mmol/L), and 78.6% (58.5–90.9%) and 100% (87.0–100%, cutoff of 6 mmol/L).Conclusions The LacP handheld lactate meter can be used safely and reliably cow-side, although it underestimates LAC value when compared with a standard laboratory analyzer especially for LAC ≥ 10.0 mmol/L. The LAC value was not influenced by HCT in this study.
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ABSTRACT: Background Preoperative L-lactatemia and heart rate have been suggested as prognostic indicators of outcome for cows with right dilatation of the abomasum or volvulus (RDA/AV). However, postoperative L-lactatemia has not been assessed as a potential prognostic tool.Objectives To determine the prognostic value of postoperative L-lactatemia (LAC2), duration of treatment (Dt), relative L-lactatemia difference (compared with preoperative L-lactatemia [LAC1]) ([LAC2 − LAC1]/LAC2) and change in L-lactate over time ([LAC2 − LAC1]/Dt) as compared to preoperative findings (LAC1 and heart rate [HR]) as prognostic factors in dairy cows with RDA/AV.AnimalsA total of 41 dairy cows were included: 19 with AV and 22 with RDA; 11 cows had a negative outcome (NO) and 30 cows had a positive outcome (PO) based on telephone follow-up with owners 30 days after surgery.Methods Prospective cohort study. Analysis was performed using logistic regression and comparison of area under the receiver operating characteristics curve (AUC) using nonparametric tests.ResultsLAC1 > 1.4 mmol/L or LAC2 > 2.2 mmol/L had the same accuracy with sensitivity of 100% (95% CI, 75.1–100%) and specificity of 80% (95% CI, 61.4–92.3%) for predicting NO. The relative L-lactatemia difference ([LAC2 − LAC1]/LAC1) or lactate kinetics ([LAC2 − LAC1]/Dt) were not associated with prognosis. The AUC of the preoperative model (which included HR and lnLAC1) was 0.92 (95% CI, 0.83–1.0) and that of the postoperative model (including only lnLAC2) was 0.95 (95% CI, 0.88–1.0); these were not significantly different.Conclusions and Clinical ImportancePostoperative L-lactatemia is helpful to predict outcome in cows with RDA/AV. The short-term change in blood L-lactate is not a useful prognostic indicator, at least during the period of time spent on the farm for surgery and treatment.
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