Validation of the handheld Lactate-Pro analyzer for measurement of blood L-lactate concentration in cattle

Identification of hemolytic anemia in Korean indigenous cattle with a criteria value of reticulocyte count, indirect bilirubin, and L-lactate concentration

Bovine hemolytic anemia has a negative impact on animal welfare and productivity due to its associated clinical symptoms. Hemolysis is generally known to cause reticulocytosis, increased indirect bilirubin, decreased concentration of haptoglobin, and increased lactate dehydrogenase. Additionally, tissue hypoperfusion due to concomitant anemia increases blood lactate concentration. However, few studies have reported the correlation between these indicators and hemolytic anemia in cattle. We expected that alterations in hematological and biochemical parameters could identify cattle with hemolytic anemia. Therefore, in addition to reporting differences in indicators according to hemolytic anemia, this study aimed to derive indicators and set criteria for identification of bovine hemolytic anemia. In cattle with hemolytic anemia, reticulocytosis, increased indirect bilirubin, and increased L-lactate were observed, and the correlation of these indicators with hematocrit (HCT) was confirmed. And since HCT alone has limitations in identifying hemolytic anemia, we suggest additional criteria to identify hemolytic anemia in cattle.

Determining lactate concentrations in Korean indigenous calves and evaluating its role as a predictor for acidemia in calf diarrhea

BACKGROUND

Calf diarrhea leads to high mortality rates and decreases in growth and productivity, causing negative effects on the livestock industry. Lactate is closely associated with metabolic acidosis in diarrheic calves. However, there have been no reports on lactate concentrations in Korean indigenous (Hanwoo) calves, especially those with diarrhea. This study aimed to determine the reference range of L-lactate and D-lactate concentrations in Hanwoo calves and to better understand the utility of lactate as predictive factors for acidemia in diarrheic calves.

RESULTS

L-lactate and D-lactate concentrations were measured in healthy (n = 44) and diarrheic (n = 93) calves, and blood gas analysis was performed on diarrheic calves. The reference range in healthy calves was 0.2-2.25 mmol/L for L-lactate and 0.42-1.38 mmol/L for D-lactate. Diarrheic calves had higher concentrations of L-lactate and D-lactate than healthy calves. In diarrheic calves, L-lactate and D-lactate each had weak negative correlation with pH (r = - 0.31 and r = - 0.35). In diarrheic calves with hyper-L-lactatemia, the combined concentrations of L-lactate and D-lactate had moderate correlation with pH (r = - 0.51) and anion gap (r = 0.55). Receiver operating characteristic analysis showed D-lactate had fair predictive performance (AUC = 0.74) for severe acidemia, with an optimal cut-off value of > 1.43 mmol/L. The combined concentrations of L-lactate and D-lactate showed fair predictive performance for predicting acidemia (AUC = 0.74) and severe acidemia (AUC = 0.72), with cut-off values of > 6.05 mmol/L and > 5.95 mmol/L.

CONCLUSIONS

The determined reference ranges for L-lactate and D-lactate in Hanwoo calves enable the identification of hyper-L-lactatemia and hyper-D-lactatemia. Diarrheic calves exhibited increased lactate concentrations correlated with acid-base parameters. While the concentrations of L-lactate and D-lactate have limitations as single diagnostic biomarkers for predicting acidemia or severe acidemia, their measurement remains important, and L-lactate has the advantage of being measurable at the point-of-care. Assessing lactate concentrations should be considered by clinicians, especially when used alongside other clinical indicators and diagnostic tests. This approach can improve calf diarrhea management, contributing positively to animal welfare and providing economic benefits to farms.

Development of a Nomogram to Estimate the 60-Day Probability of Death or Culling Due to Severe Clinical Mastitis in Dairy Cows at First Veterinary Clinical Evaluation

Severe clinical mastitis is a frequent disease of dairy cattle. An effective mean of predicting survival despite treatment would be helpful for making euthanasia decisions in poor prognosis cases. The objective was to develop a nomogram for prediction of death or culling in the 60 days following a severe mastitis episode in dairy cows at first veterinary visit in farm settings. A total of 224 dairy cows presenting severe clinical mastitis and examined for the first time by a veterinarian were included in a prospective study. Clinical and laboratory (complete blood cell count, L-lactate, cardiac troponin I, milk culture) variables were recorded. Animals were followed for 60 days. A nomogram was built with an adaptive elastic-net Cox proportional hazards model. Performances and relevance were evaluated by area under the receiver operating characteristic curve (AUC), Harrell’s concordance index (C-index), calibration curve, decision curve analysis (DCA) and misclassification cost term (MCT). The nomogram included: lactation number, recumbency, depression intensity, capillary refilling time, ruminal motility rate, dehydration level, lactates concentration, hematocrit, band neutrophils count, monocyte count, and milk bacteriology. The AUC and C-index showed a good calibration and ability to discriminate. The DCA suggested that the nomogram was clinically relevant. Euthanizing animals having less than 25% probability of survival is economically optimal. It could be used for early euthanasia decisions in animals that would not survive despite treatment. To facilitate the use of this nomogram by veterinarians, a web-based app was developed.

Admission lactate concentration has predictive value for death or severe complications within 30 days after admission in cattle with long-bone fractures

OBJECTIVE

To determine the prognostic value of lactate concentration measurements at admission in cattle with long-bone fractures.

ANIMALS

43 cattle with long-bone fractures between July 2016 and Dec 2018.

PROCEDURES

In this prospective cohort study, lactate concentration was measured in systemic venous blood and locally in capillary blood sampled from the fractured and contralateral limbs of cattle and assessed for outcome prediction. The cutoff value was determined by maximizing the Youden index from receiver-operating characteristic curves. Multivariable logistic regression was employed to verify whether higher lactate concentrations compared with the cutoff value were an independent risk factor for poor outcomes at 30 days or 3 years after admission.

RESULTS

Poor outcome was associated with higher capillary lactate concentration in the fractured limb (P < .001) and greater difference with systemic blood (P = .005). A cutoff value of lactate difference ≥ 2.4 mmol/L (sensitivity = 0.80; specificity = 0.965) between capillary lactate in the fractured limb and systemic blood was the best predictor of death ≤ 30 days after admission (P < .001). Multivariable analysis revealed that this cutoff value was an independent risk factor for 30-day and 3-year outcomes (P < .001).

CLINICAL RELEVANCE

Admission blood lactate concentration difference ≥ 2.4 mmol/L between the fractured limb and systemic blood was a robust and independent predictor of outcome for cattle of the present report. Lactate metabolism is locally impaired in fractured limbs of nonsurviving or at higher complication risk cattle, which may help identify patients at high risk for poor outcomes.

Additive prognostic value of preoperative plasma glucose concentrations in calves undergoing abdominal surgery

Surgical abdominal emergencies in calves are associated with a guarded prognosis, especially if neonates are affected. Because hypoglycemia has been associated with sepsis and endotoxemia, this study aimed to assess the prognostic relevance of preoperative plasma glucose concentrations (GLUC) in calves requiring surgery for an acute abdominal disorder. For this purpose, data from retrospective and prospective case series were analyzed, consisting of 586 and 83 hospitalized calves, respectively. The outcomes of calves were evaluated until hospital discharge (both study populations) and for 3 mo following discharge by a phone call to the farmer (prospective study population). For the retrospective study population, the overall survival rate was 31.2%. Calves with a negative outcome (NO) had significantly lower median GLUC (4.3 mmol/L) than calves with a positive outcome (PO; 5.0 mmol/L). The survival rates of calves with GLUC <2.4 mmol/L and 2.4 to 3.1 mmol/L were 3.6 and 8.3%, respectively. The inclusion of GLUC improved a previous prognostic model based on plasma l-lactate concentration and age. The resulting analyses indicated that NO was associated with low age (<7 d), hyper-l-lactatemia (>8.84 mmol/L), and GLUC <4.4 mmol/L (age 7-20 d) and <3.3 mmol/L (age ≥21 d), respectively. The area under the receiver operating characteristic curve of this model was 0.79 (95% confidence interval: 0.76-0.83) and the resulting sensitivity and specificity for NO at the optimal probability cut-point of 0.69 were 66.7 and 85.8%, respectively. For the prospective study population, the established model had sensitivity and specificity for predicting NO after 3 mo (proportion 24%) of 61.9 and 85%, respectively. In both study populations, hypoglycemia was significantly associated with intraoperative evidence of a septic process within the abdominal cavity. The present analyses show that hypoglycemia was highly indicative of a poor prognosis and serious intraoperative findings such as peritonitis. Determination of GLUC should therefore be part of the diagnostic work-up in calves suffering from an acute abdominal emergency.

Prognostic utility of pre- and postoperative plasma l-lactate measurements in hospitalized cows with acute abdominal emergencies

The aim of the present analyses was to compare the prognostic value of pre- and postoperative l-lactate measurements in hospitalized cows requiring surgical intervention for an acute abdominal emergency, such as gastrointestinal ileus or peritonitis. For this purpose, we analyzed data from retro- and prospective case series, consisting of 754 and 98 cows, respectively. Plasma l-lactate concentrations (L-LAC) were determined upon admission to the hospital (both study populations), immediately before initiation of surgical intervention (prospective study population), and 6, 12, 24, 48, and 72 h later (prospective study population). The outcome of cows was evaluated until hospital discharge (both study populations) and 3 mo after discharge by a phone call to the farmer (prospective study population). A negative outcome was defined as death or euthanasia during hospitalization, or if discharged animals had an unsatisfied owner or were culled for medical reasons that were directly related to the initial abdominal emergency. For the retrospective study population, the overall survival rate until hospital discharge was 66%. Cows with a negative outcome (median: 6.81 mmol/L) had significantly higher L-LAC than cows with a positive outcome (3.66 mmol/L) of therapy. At the individual diagnosis level, L-LAC was associated with mortality in cows with a diagnosis of abomasal volvulus, local peritonitis, hemorrhagic bowel syndrome, and jejunal volvulus. Considering the whole study population, the area under the receiver operating characteristic curve was 0.66. For the prospective study population, the proportion of cows with a positive outcome was 65% until hospital discharge and 61% after the 3-mo observation period. At all sampling times, before and during the first 12 h after surgical intervention, cows with a negative outcome had significantly higher L-LAC than cows with a positive outcome. The largest area under the receiver operating characteristic curve for L-LAC was observed at 6 h (0.89). A cut-point of 1.77 mmol/L was identified, which had a sensitivity and specificity for predicting a negative outcome until hospital discharge of 88.9 and 73.4%, respectively. The present analyses confirmed previous findings in calves and show that persistent hyper-l-lactatemia during the early postoperative period is a more reliable indicator for a negative outcome than hyper-l-lactatemia before initiation of surgical intervention.

Prognostic relevance of pre- and postoperative plasma l-lactate measurements in calves with acute abdominal emergencies

In both human and veterinary medicine, l-lactate is a well-established prognostic biomarker of disease severity and mortality and has also attracted increasing attention in bovine medicine due to the availability and validation of cheap and portable l-lactate analyzers. The aim of the present study was to evaluate the prognostic accuracy of plasma L-lactate measurements in calves with acute abdominal emergencies before and during the initial therapeutic period after surgical intervention. A prospective observational study was carried out involving 83 hospitalized calves up to an age of 7 mo, which required surgical intervention for reasons of an acute abdominal emergency such as gastrointestinal ileus or peritonitis. Plasma l-lactate (L-LAC) concentrations were determined immediately before initiation of surgery and 6, 12, 24, 48, and 72 h later. The outcome of calves was evaluated 3 mo after discharge by a phone call to the farmer, and a positive outcome was defined if the calf was still alive and the owner was satisfied with the animal's postsurgical progress. A total of 29% of calves were discharged from the hospital and the proportion of calves with a positive outcome after the 3-mo period was 24%. At all sampling times during the first 48 h after initiation of surgical intervention, calves with a negative outcome had significantly higher L-LAC than calves with a positive outcome. A binary logistic regression analysis indicated that the odds for a negative outcome during the 3-mo observation period increased by a factor of 1.23 [95% confidence interval (CI): 1.04-1.44] for every mmol/L increase of L-LAC before initiation of surgical intervention, but by a factor of 5.29 (95% CI: 1.69-16.6) and 5.92 (95% CI: 1.29-27.3) at 12 and 24 h, respectively. The largest area under the receiver operating characteristic curve for L-LAC was observed at 12 h (0.91; 95% CI: 0.83-0.99), and a cut-point of 2.75 mmol/L was identified that had a sensitivity and specificity for predicting a negative outcome of 68 and 100%, respectively. In conclusion, persistent hyper-l-lactatemia during the early postoperative period is a more reliable indicator for a negative outcome in calves with acute surgical abdominal emergencies than hyper-l-lactatemia before initiation of surgical intervention. Postoperative measurements of L-LAC are therefore a clinically useful tool to identify patients with an increased risk for a negative outcome at an early stage after surgical intervention was carried out.

Prognostic value of preoperative plasma l-lactate concentrations in calves with acute abdominal emergencies

Acute abdominal emergencies in calves due to abomasal disorders, gastrointestinal ileus, or peritonitis are characterized by a rapid disease progression and usually require immediate surgical intervention. Those conditions are associated with a guarded prognosis, and the aim of the present study was to assess the prognostic relevance of preoperatively measured plasma l-lactate concentrations (l-LAC) in a large study population of calves with a broad spectrum of acute abdominal emergencies. For the purpose of this study, the medical records of 587 calves admitted to a veterinary teaching hospital over a 10-yr period were analyzed retrospectively. Plasma l-LAC was measured as part of a routinely performed biochemistry panel before initiation of surgical intervention. Hyper-l-lactatemia (plasma l-LAC >2.2 mmol/L) was evident in 75% of calves, and the overall survival rate until hospital discharge was 31%. Calves with a negative outcome were younger (median: 3.4 vs. 6 wk) and had higher plasma l-LAC (median: 4.96 vs. 3.09 mmol/L) than calves with a positive outcome. At the individual diagnosis level, l-LAC was associated with mortality in calves with a diagnosis of mesenteric torsion, right-sided dilated abomasum, small intestinal volvulus, or paralytic ileus, but not in calves suffering from peritonitis, malformations, abomasal volvulus, bloat, or small intestinal intussusceptions. Considering the whole study population, the area under the receiver operating characteristic (ROC) curve for plasma l-LAC was 0.66 [95% confidence interval (CI): 0.61-0.70]. A classification tree analysis indicated that l-LAC >8.84 mmol/L and age categories of <3 wk and <1 wk were independent predictors of mortality. The area under the ROC curve of this model was 0.75 (95% CI: 0.71-0.79) and the resulting sensitivity and specificity for the prediction of nonsurvival at the optimal probability cut-point of 0.62 were 67.7 and 76.6%, respectively. In conclusion, hyper-l-lactatemia is common in calves suffering from acute abdominal emergencies. Markedly increased plasma l-LAC is associated with an increased mortality risk, but it is not possible to reliably predict the outcome of affected calves based on a single, preoperative measurement. However, a clinically important finding of this study was that the ability to predict a negative outcome is improved when the age of the calf is considered in addition to plasma l-LAC.

Prognostic Value of Cardiac Troponin I and L-Lactate in Blood of Dairy Cows Affected by Downer Cow Syndrome

Background

The downer cow syndrome (DCS) is a challenging health issue in the dairy industry. No cow‐side test is available to provide an accurate prognosis for DCS cases in farm settings.

Hypothesis/Objectives

Local or systemic hypoperfusion and myocardial lesions lead to an increase in blood concentration of biomarkers cardiac troponin I (cTnI) and L‐lactate. The objective was to determine the prognostic values of these biomarkers assessed cow‐sides in addition to clinical examinations in prognostication of a negative outcome (NO: death or euthanasia within 7 days).

Animals

218 client‐owned dairy cows affected by DCS.

Methods

In a prospective study, animals were monitored for 60 days after inclusion of each cow. Blood cTnI and L‐lactate concentrations were measured on the day of inclusion. The prognostic accuracy of both biomarkers and physical examination variables was estimated to predict NO. A mixed multivariable logistic regression model was used for data analysis.

Results

Prevalence of NO in this study was 63% on day 7. Troponin concentrations greater than 0.7 ng/mL had sensitivity and specificity of 54.1% (95% CI: 45.3–62.7%) and 78.4% (95% CI: 67.3–87.1%), respectively, for predicting NO. Blood L‐lactate was not associated with the outcome. The multivariable model revealed that heart rate >100 bpm (OR; 95% CI: 3.7; 1.3–10.2) and cTnI > 0.7 ng/mL (OR; 95% CI: 5.5; 2.1–14.6) were associated with the risk of NO.

Conclusions and Clinical Importance

Hypertroponinemia and tachycardia were associated with reduced survival in DCS cases. The use of cow‐side blood cTnI concentrations and heart rate could help to rapidly identify cows in farm setting that have poor chances of recovery and would benefit from a more aggressive treatment or euthanasia.

Assessment of a portable lactate meter for field use in the white rhinoceros (<i>Ceratotherium simum</i>)

Blood lactate is a predictor of mortality in critically ill humans and animals. Handheld lactate meters have the potential to be used in the field to evaluate the condition of severely injured rhinoceroses but have not been compared with laboratory-based methods. Agreement between a handheld lactate meter and a laboratory method was assessed, as was the stability of rhino blood lactate in the anticoagulant sodium fluoride/potassium oxalate (fluoride/oxalate). Blood samples were obtained from 53 white rhinos that had been immobilised for management reasons. Lactate was measured by means of a handheld meter using whole blood in heparin (WBHEP), whole blood in fluoride/oxalate (WBFO) and fluoride/oxalate plasma (PFO). Results were recorded in both blood (BL) and plasma (PL) modes and compared to an established laboratory method for measuring plasma lactate. To assess the stability of lactate over time, blood lactate in fluoride/oxalate was measured on the handheld meter at intervals for up to 91 h. Agreement was best using WBFO in PL mode, with small bias (−0.16), tight 95% limits of agreement (LOA) (−1.46, 1.14) and a Pc (95% CI) of 0.97 (0.92, 0.99). The agreement was improved for all sample types when using the PL mode compared to the blood lactate (BL) mode. Blood lactate was stable in fluoride/oxalate for 91 h, with a mean change from baseline of 0.15 (−0.178, 0.478) mmol/L (mean, 95% CI). The handheld meter was found to be suitable for field use in white rhinos but provided more reliable results with the device in PL mode. Furthermore, rhino blood lactate was found to be stable in fluoride/oxalate for as long as 3 days.

Blood lactate concentration as diagnostic predictors of uterine necrosis and its outcome in dairy cows with uterine torsion

In order to determine blood lactate concentrations (bLac) and their validity as a diagnostic marker in bovine uterine torsion, blood samples were taken from 54 Holstein cows with uterine torsion before the correction of torsion. bLac in a group of cows with and without uterine necrosis were 15.0 and 3.0 mmol/l, respectively (P<0.01). Moreover, bLac in a group of dead or culled dams and in that of survived dams were 10.2 and 3.1 mmol/l, respectively (P<0.01). Furthermore, the proposed diagnostic cutoffs for bLac based on ROC analysis for detection of uterine necrosis and poor prognosis in dams were set at >5.0 and >6.5 mmol/l, respectively. These findings suggest that in dairy cows with uterine torsion, an increase in bLac is a diagnostic predictor of uterine necrosis as well as poor prognosis in dams.

Point-of-care devices for physiological measurements in field conditions. A smorgasbord of instruments and validation procedures

Point-of-care (POC) devices provide quick diagnostic results that increase the efficiency of patient care. Many POC devices are currently available to measure metabolites, blood gases, hormones, disease biomarkers or pathogens in samples as diverse as blood, urine, feces or exhaled breath. This diversity is potentially very useful for the comparative physiologist in field studies if proper validation studies are carried out to justify the accuracy of the devices in non-human species under different conditions. Our review presents an account of physiological parameters that can be monitored with POC devices and surveys the literature for suitable quantitative and statistical procedures for comparing POC measurements with reference "gold standard" procedures. We provide a set of quantitative tools and report on different correlation coefficients (Lin's Concordance Correlation Coefficient or the more widespread Pearson correlation coefficient), describe the graphical assessment of variation using Bland-Altman plots and discuss the difference between Model I and Model II regression procedures. We also report on three validation datasets for lactate, glucose and hemoglobin measurements in birds using the newly proposed procedures. We conclude the review with a haphazard account of future developments in the field, emphasizing the interest in lab-on-a-chip devices to carry out more complex experimental measurements than the ones currently available in POC devices.

Assessment of L-lactatemia as a predictor of respiratory disease recognition and severity in feedlot steers

The bovine respiratory disease complex (BRD) is a major health issue in feedlot cattle and one of the primary reasons for antimicrobial use in the North American feedlot industry. The purpose of the present study was to assess blood L-lactate levels of feedlot steers at high risk of developing BRD during the early feeding period. Blood samples were obtained at initial processing and again after BRD confirmation (using bronchial lavage or thoracic ultrasound exam). The study involved 232 recently weaned steers received at a single research feedlot that were processed without metaphylactic antimicrobial treatment. Blood samples were obtained for determination of L-lactatemia and temperament scores (very quiet or stoic [score 1], average [score 2] and very excited [score 3]) were systematically assigned at initial processing. A subsample of calves that were later confirmed as cases of BRD were sampled at first pull (day 0), and at subsequent observation points on days 3, 6, 9 and 15 following initial BRD diagnosis for blood lactate determination as a potential indicator of subsequent death. The clinical BRD cumulative incidence in the cohort was 38% (87/232). Temperament was associated with the probability of becoming a BRD case during the early feeding period. Stoic or very excited calves showed 2.2 times higher odds (95%CI: 1.3, 3.8) of becoming BRD cases compared to calves with average temperament. The impact of L-lactatemia differed by temperament strata. In calves with a temperament score of 2 (average temperament) every 1-log unit increase of lactatemia at processing resulted in 1.9 times higher odds (95% CI: 1.2, 3.1) of becoming a BRD case; this relationship was not significant in calves with a score of either 1 or 3. Twenty-nine confirmed BRD cases were studied for the dynamic lactate assessment analysis. L-lactate at first pull was not significantly different between survivors (median 3.3mmol/L; range 0.8-7.8mmol/L) and non-survivors (median 2.7mmol/L; range: 1.6-5.4mmol/L) steers. However, the dynamic assessment of L-lactatemia was associated with the hazard of death using Cox proportional hazard survival analysis. A 1-log increase of lactatemia increased the hazard of dying prior to the next observation by a factor of 36.5 (95% CI: 3.5-381.6). For calves showing a normal temperament score (i.e. temperament score of 2), a misclassification cost term analysis was conducted to identify potential L-lactate test thresholds for identifying future BRD steers. When planned test usage was for informing decision of administering or not a metaphylactic treatment at processing, experts agreed that false-negative (not treating a calf that would have benefit from treatment) to false-positive (wrongfully treating a calf that would have remained healthy) health costs ratio ranged from 8:1 to 20:1. In this situation, a threshold of 5mmol/L would have best informed treatment decision. When using L-lactate for informing the type of antimicrobial used at processing, false-negative to false-positive health costs ratio ranging from 1:1 to 3:1 could be expected and, again, a L-lactate threshold of 5.0mmol/L would have minimized the costs associated with calves' misclassification and could be used to identify calves that would benefit from a more efficient metaphylactic treatment. This study provides an interesting perspective on the potential application of chute-side markers or diagnostic tests to stratify the risk of future pull for BRD in cattle during processing in order to adapt antimicrobial treatments accordingly.

Preoperative and postoperative L-lactatemia assessment for the prognosis of right abomasal disorders in dairy cattle

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.

ANIMALS

A 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.

RESULTS

LAC1 > 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 IMPORTANCE

Postoperative 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.