Technical note: Evaluation of the diagnostic accuracy of 2 point-of-care β-hydroxybutyrate devices in stored bovine plasma at room temperature and at 37°C

The use of point-of-care (POC) devices to measure blood metabolites, such as β-hydroxybutyrate (BHB), on farm have become an important diagnostic and screening tool in the modern dairy industry. The POC devices allow for immediate decision making and are often more economical than the use of laboratory-based methods; however, precision and accuracy may be lower when measurements are performed in an uncontrolled environment. Ideally, the advantages of the POC devices and the standardized laboratory environment could be combined when measuring samples that do not require an immediate result-for example, in research applications or when immediate intervention is not the goal. The objective of this study was to compare the capability of 2 POC devices (TaiDoc, Pharmadoc, Lübeck, Germany; Precision Xtra, Abbott Diabetes Care, Abingdon, UK) to measure BHB concentrations either at room temperature (RT; 20-22°C) or at 37°C compared with the gold standard test in stored plasma samples. Whole blood from multiparous Holstein dairy cows (n = 113) was sampled from the coccygeal vessels between 28 d before expected calving and 42 DIM. Whole-blood BHB concentrations were determined cow-side using the TaiDoc POC device. Plasma was separated within 1 h of collection and stored until analysis. A subset of stored plasma samples (n = 100) consisting of 1 sample per animal was chosen retrospectively based on the BHB concentrations in whole blood within the range of 0.2 to 4.0 mmol/L. The samples were analyzed for BHB plasma concentration using an automated chemistry analyzer (Hitachi 917, Hitachi, Tokyo, Japan), which was considered the gold standard. On the same day, the samples were also measured with the 2 POC devices, with samples either at RT or heated up to 37°C. Our study showed high Spearman correlation coefficients (>0.99) using either device and with samples at both temperatures compared with the gold standard. Passing-Bablok regression revealed a very strong correlation (>0.99), indicating good agreement between both POC devices and the gold standard method. For hyperketonemia detection, defined as BHB concentration ≥1.2 mmol/L, the sensitivity for both POC devices at RT and 37°C was equally high at 100%. Specificity was lowest (67.4%) for the TaiDoc used with plasma at RT and was highest (86.5%) when plasma was measured at 37°C with the Precision Xtra meter. Bland-Altman plots revealed a mean bias of 0.25 and 0.4 mmol/L for the Precision Xtra meter and TaiDoc, respectively, when tested on plasma at 37°C. Our data showed that both POC devices are suitable for measuring BHB concentration in stored bovine plasma, and accuracy was highest when samples were heated to 37°C compared with RT.