Use of reagent test strips for diagnosis of endometritis in dairy cows

The use of leukocyte esterase (LE), protein, and pH tests were evaluated on widely available urinary test strips (Multistix 10 SG; Bayer Corporation, Elkart, IN, USA) on uterine lavage samples as a potential cow-side test for the diagnosis of cytologic endometritis. Uterine lavage samples of 563 lactating Holstein cows between 40 and 60 days postpartum from 28 herds were evaluated. Endometrial cytology was used as the reference for endometritis, with a cutoff point of ≥10% neutrophils. All three (LE, protein, and pH) were increased in cows with cytologic endometritis and the associations were highly significant. Optimal cutoff points determined by receiver operating characteristic analysis for LE, protein, and pH were ≥++, ≥300 mg/dL, and ≥7.0, respectively. Combining the results for LE and pH improved the performance of the test strip, but this resulted in a group of cows (20.6% of cows) which were approximately equally likely (46% with endometritis and 54% without endometritis) to have cytologic endometritis or not, and therefore could not be accurately classified. The direct relationship between reagent strip test and reproductive performance was also evaluated. Reproductive impairment due to endometritis was restricted to multiparous cows; significantly decreased reproductive performance was observed for multiparous cows with lavage fluid LE ≥+++ (154 vs. 115 median days not-pregnant), as well as cows with pH ≥ 7.0 (150.5 vs. 111.5 median days not-pregnant), but not in cows with high protein, even at the highest cutoff point. In conclusion, reagent strip test results were strongly associated with cytologic endometritis and reproductive impairment; however, in comparison with conventional cytology, the performance of reagent strip as an alternative test was relatively poor and may require further refinement.