Short communication: Validation of a test-day milk test for β-hydroxybutyrate for identifying cows with hyperketonemia

Subclinical ketosis is a common metabolic disorder affecting dairy cattle that results in a greater risk for the development of subsequent metabolic and infectious disease. Canwest Dairy Herd Improvement (DHI; Guelph, ON, Canada) has begun to use an infrared test (MilkoScan FT600, Foss Analytical A/S, Hillerød, Denmark) applied to metered composite milk samples to detect β-hydroxybutyrate (BHB) levels as a herd surveillance test for hyperketonemia. However, the test has not been compared with the gold standard, serum BHB as determined in a reference diagnostic laboratory. The objective of this cross-sectional diagnostic accuracy study was to validate the DHI milk BHB test to identify cows with hyperketonemia as determined by quantification of BHB in serum. A total of 316 cows from 17 dairy herds in southwestern Ontario had a milk and blood sample taken. Milk was collected at a routine DHI test, and blood from the same cow was sampled within 24 h of the milk test. The BHB concentration in milk was determined using the DHI milk BHB test, and serum was sent to the Animal Health Laboratory at the University of Guelph (Guelph, ON, Canada). A nonparametric receiver operating characteristic curve was generated to compare DHI milk BHB concentrations with serum BHB concentrations. Overall, a total of 34 cows (11%) had a level of serum BHB ≥1.2 mmol/L. The concentration of DHI milk BHB was moderately correlated with the concentration of serum BHB, yielding a coefficient of determination value of 0.61. The optimal cut point for determining hyperketonemia (≥1.2 mmol/L) on the DHI milk BHB test was ≥0.14 mmol/L, yielding a sensitivity of 81% and specificity of 92%. The performance of the DHI milk BHB test varied depending on the days in milk (DIM) of the cows tested, with a higher specificity being found in cows that were ≤25 DIM compared with cows tested >25 DIM. If the herd-level prevalence of hyperketonemia was ≥14%, the DHI milk BHB test had an improved sensitivity when compared with a herd-level prevalence of <14%. This study demonstrates that the DHI milk BHB test is a reliable measure for evaluating hyperketonemia using routine DHI milk samples and could be used as a herd-level monitoring tool for ketosis when evaluating nutritional management or preventative medicine strategies.