Assessment of a point‐of‐care test for measurement of blood triglyceride levels for rapid detection of equid hypertriglyceridaemia

Abstract

Summary This project investigated the clinical value of a human whole blood point‐of‐care (POC) triglyceride (TG) measurement device to determine equid blood TG concentrations. Equid plasma TG measurements were determined in a commercial laboratory and also using whole blood and plasma on the POC device from equid patients with TG concentrations from within the normal range to severely hypertriglyceridaemic. Results were compared between methods using the Bland‐Altman method for validation. Seventy‐four samples were collected: 35 from inappetent or starved equid patients (considered ‘at‐risk’ of developing hypertriglyceridaemia) and 39 from equids eating with a normal appetite. The POC device readable range is 0.8–6.86 mmol/l; high readings were diluted and measurements repeated and calculated. Inappetent/starved patients had a higher risk of developing raised plasma triglycerides (OR 16.8, 95% CI 4.8–58.4, P<0.0001) than the appetent ones with 34% (12/35) having mildly increased TG and 31% (11/35) having moderately to severely increased TG concentrations. In comparison, there were no severely hypertriglyceridaemic patients, one moderately increased and 3/39 (8%) mildly elevated TG patients in the appetent group. In the readable range, using whole blood, the POC device had excellent agreement with the laboratory (mean difference ‐0.59). However, accuracy varied with TG concentration and the POC instrument overestimated TG values, particularly when TG values were above the POC device's range. For a given value in the readable range of the POC device, multiplication of the POC value by a factor of 0.77 (whole blood) and 0.72 (plasma) provides an estimation of the laboratory TG value. Whole blood TG readings below the POC instrument's range were reliably low. The POC device reliably predicted TG values in a clinical setting. Use of this device provides rapid, easy to perform, reliable assessment of blood TG concentration in equids at risk of developing hypertriglyceridaemia.

Validation of the Accutrend Plus point‐of‐care triglyceride analyzer in horses, ponies, and donkeys

“…Assessment of method agreement revealed that the POC analyzer systemically overestimated triglyceride concentrations when compared to a standard laboratory assay. This finding was in concordance with the results of previous studies in dogs, cats, and horses . Disagreement appeared to be more pronounced in horses and ponies compared to donkeys, and the absolute disagreement between methods increased with rising triglyceride concentrations.…”

“…Assuming that the POC analyzer is calibrated by default for use with capillary blood, this could explain why it overestimates (in comparison with a standard assay designed for use with jugular venous blood) triglyceride concentrations when used with jugular venous blood. In fact, in the other studies in which similar disagreement between the POC analyzer and the standard laboratory assay was detected, analyses were also performed using native or anticoagulated jugular venous blood . Conversely, in a human study utilizing whole capillary blood samples, mean bias between the POC analyzer and a standard laboratory assay was low at <1% .…”

“…However, clinical signs of hypertriglyceridemia are unspecific or related to underlying disease processes. Furthermore, hypertriglyceridemia can occur without evidence of serum opacity . Therefore, preventive monitoring of blood triglyceride concentrations is crucial for early detection of disease in equids that are at risk for hypertriglyceridemia.…”

“…A pocket‐sized POC analyzer a designed for measurement of blood glucose, lactate, cholesterol, and triglyceride concentrations in people has recently become available and has been validated for use in small animals . Accuracy and reliability of this assay for measurement of blood triglyceride concentrations have also been reported for hyperlipemic equids . However, the assay has not been validated for different populations of horses, ponies, and donkeys.…”

Donkey Internal Medicine—Part I: Metabolic, Endocrine, and Alimentary Tract Disturbances

“…Hyperlipemia can be suspected based on clinical signs, plasma, or serum turbidity but is confirmed by measuring serum triglyceride concentrations. There are point-of-care sensitive triglyceride analyzers available in the market [14], which could be recommendable for farms with large number of donkeys. Clinicians should also know that because the upper reference limit for triglyceride concentrations (248 mg/dL) is higher in healthy donkeys than horses and ponies [15], the accepted definitions for hypertriglyceridemia (<500 mg/dL) and lipemia/hyperlipemia (>500 mg/dL) in horses and ponies may not be suitable for donkeys.…”