Arginine or Hypertonic Saline–Stimulated Copeptin to Diagnose Arginine Vasopressin (AVP) Deficiency
Performance · Diagnostic accuracyResult — go to the resultEstimated difference −21.2 percentage points 95% CI −28.7 to −14.3Authors' conclusion
Among adult patients with polyuria polydipsia syndrome, AVP deficiency was more accurately diagnosed with hypertonic saline-stimulated copeptin than with arginine-stimulated copeptin.
Study context
- Population
- Adults with polydipsia and hypotonic polyuria or known AVP deficiency; final diagnosis by two endocrinologistsunderwent both tests
- Participants
- 158 adults
- Comparison
- Arginine-stimulated copeptin vs hypertonic saline-stimulated copeptin
- Outcome
- Overall diagnostic accuracy at prespecified copeptin cutoffs
Methodological detailsinternational, noninferiority, head-to-head comparison
- International
- Noninferiority
- Head-to-head comparison
Performance
Diagnostic accuracy
Estimated difference
−21.2 percentage points
95% CI −28.7 to −14.3
By group
Argininevs Hypertonic saline
estimated difference −21.2 percentage points (95% CI −28.7 to −14.3)
As reported in the abstract
Further findings
- Alternative arginine-stimulated copeptin cutoffs
- 90.9% · Specificity for AVP deficiency at ≤3.0 pmol per liter (95% CI 81.7 to 95.7) · Specificity for primary polydipsia at >5.2 pmol per liter (95% CI 83.7 to 95.6) 91.4%
Final diagnosis
- AVP deficiency
- 69 (44%)
- Primary polydipsia
- 89 (56%)
Patient preference
- Preferred arginine over hypertonic saline testing
- 72%
Safety
- Adverse events were generally mild with the two tests
Original publication
Arginine or Hypertonic Saline–Stimulated Copeptin to Diagnose AVP Deficiency. N Engl J Med. Published 16 November 2023. doi:10.
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