A plasma biomarker such as ubiquitin carboxyl-terminal hydrolase L1 (UCHL-1) to distinguish neonatal encephalopathy (NE) from other disorders and provide prognostic information would be useful for equine practitioners. In this prospective study, plasma UCHL-1 was measured in 331 hospitalized foals ≤ 4 days of age. Clinical diagnoses of neonatal encephalopathy only (NE group, n=77), sepsis only (Sepsis group, n=34), concurrent sepsis and NE (NE+Sepsis group, n=85), or neither sepsis nor NE (Other group, n=101) were made by the attending veterinarian. Plasma UCHL-1 concentrations were measured by ELISA. Differences between clinical diagnoses groups were evaluated and receiver operator curve (ROC) analysis was performed to assess diagnostic and prognostic performance. Median admission UCHL-1 concentration was significantly higher for NE (18.22 ng/ml; 7.93-37.43) and NE+Sepsis (17.42 ng/ml; 7.67-36.24) groups than Other foals (7.77 ng/ml; 3.92-22.76). Admission UCHL-1 was significantly higher in non- survivors (16.66 ng/ml; 6.89-34.84) than survivors (10.27 ng/ml; 5.82-29.94). Overall diagnostic performance of admission UCHL-1 concentration for NE diagnosis was determined (AUC 0.61; 95% confidence interval [CI]= 0.55-0.68); sensitivity and specificity for predicting NE were 73% and 49% respectively. Overall prognostic performance of time to lowest UCHL-1 concentration for predicting non- survival was determined (AUC 0.72; 95% CI = 0.65-0.79); sensitivity and specificity were 86% and 43% respectively. In this foal population, differences in plasma UCHL-1 concentrations were observed between foals with NE or NE with sepsis, and other diagnoses. The diagnostic and prognostic value of admission UCHL-1 concentration was limited.
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