Downer cow syndrome, a common problem in dairy cattle, represents a diagnostic and therapeutic challenge for the attending veterinarian. Identifying prognostic indicators and assessing the odds of survival may improve the accuracy of the clinician's prognosis at the time of diagnosis. To describe a population of downer dairy cows referred to a hospital and investigate predictors of outcome. Recumbent adult dairy cows (cows unable or unwilling to stand without help) treated at a referral

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... . Data at the time of admission were collected from medical records of downer dairy cows treated at the Centre Hospitalier Universitaire Vétérinaire between 1994 and 2016. Simple and multivariable logistic regression analyses were performed to assess the association of predictors with the outcome. Among 1318 cows included, 727 (55%) cows were discharged, and 591 (45%) cows died or were euthanized. Cows with longer time of recumbency before referral (odds ratio [OR] = 3.6), tachycardia (100-120 beats per minute [bpm], OR = 1.93; >120 bpm, OR = 2.92), tachypnea (OR = 1.76), hypothermia (OR = 2.08), anemia (OR = 3.30), neutropenia (OR = 1.7), high aspartate aminotransferase activity (500-1000 U/L, OR = 2.16; >1000 U/L, OR = 6.69), and increased serum creatinine concentration (OR = 1.75) had higher odds of nonsurvival. These findings may help the practitioner to consider treatment options and decide if referral is likely beneficial based on the odds of success. Early recognition of low chance of survival may facilitate an early decision for euthanasia.