A novel diagnostic score for diagnosing arginine vasopressin deficiency (central diabetes insipidus) or primary polydipsia with basal laboratory and clinical parameters: results from two international multicentre prospective diagnostic studies
Errata to this article were published (Lancet Diabetes Endocrinol, Jun 2025 ↗ · Jun 2025 ↗)
Authors' conclusion
We introduce a stepwise diagnostic approach, starting with basal laboratory tests and rule-in and rule-out criteria for immediate treatment. For intermediate cases, the novel score aids in identifying arginine vasopressin deficiency or primary polydipsia with high accuracy. This approach could lead to shortening the diagnostic timeline and reducing dependence on stimulation or dynamic tests.
Study context
- Population
- Adults with polydipsia (>3 L/day) and hypotonic polyuria, or a previous diagnosis of AVP-D, undergoing the hypertonic saline test (CODDI, CARGOx; Switzerland, Germany, Netherlands, Italy, UK, Brazil)141 development, 158 validation
- Participants
- 299 adults
- Comparison
- Basal laboratory parameters and a clinical diagnostic score for AVP-D vs primary polydipsia
- Outcome
- Diagnostic performance in predicting AVP-D (ROC AUC, sensitivity, specificity)
Methodological detailsdevelopment and validation cohorts, two international multicentre prospective diagnostic studies, Cutoffs derived in the first study (development), performance determined in the second study (validation)
- Development and validation cohorts
- Two international multicentre prospective diagnostic studies
- Cutoffs derived in the first study (development), performance determined in the second study (validation)
Performance
As reported in the abstract
Diagnosis of AVP-D vs primary polydipsia, validation cohort
| Test or model | AUC | Specificity for AVP-D (>145 mmol/L) | Specificity for primary polydipsia (<135 mmol/L) | Specificity for primary polydipsia (>5.6 pmol/L) | Specificity for primary polydipsia (<415 points) | Specificity for AVP-D (>461 points) | Overall accuracy for AVP-D (>441 points) |
|---|---|---|---|---|---|---|---|
| Basal plasma sodium | — not stated in the abstract | 100% (95% CI 61-100) | 100% (34-100) | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract |
| Plasma copeptin | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract | 100% (74-100) | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract |
| Clinical score | 91% (87-96) | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract | 93% (87-99) | 93% (88-98) | 86% (80-91) |
AUC
Basal plasma sodium— not stated in the abstract
Plasma copeptin— not stated in the abstract
Clinical score91% (87-96)
Specificity for AVP-D (>145 mmol/L)
Basal plasma sodium100% (95% CI 61-100)
Plasma copeptin— not stated in the abstract
Clinical score— not stated in the abstract
Specificity for primary polydipsia (<135 mmol/L)
Basal plasma sodium100% (34-100)
Plasma copeptin— not stated in the abstract
Clinical score— not stated in the abstract
Specificity for primary polydipsia (>5.6 pmol/L)
Basal plasma sodium— not stated in the abstract
Plasma copeptin100% (74-100)
Clinical score— not stated in the abstract
Specificity for primary polydipsia (<415 points)
Basal plasma sodium— not stated in the abstract
Plasma copeptin— not stated in the abstract
Clinical score93% (87-99)
Specificity for AVP-D (>461 points)
Basal plasma sodium— not stated in the abstract
Plasma copeptin— not stated in the abstract
Clinical score93% (88-98)
Overall accuracy for AVP-D (>441 points)
Basal plasma sodium— not stated in the abstract
Plasma copeptin— not stated in the abstract
Clinical score86% (80-91)
— not stated in the abstract
- Stepwise approach enabled diagnosis
- 223 (75%) of 299 patients
Original publication
A novel diagnostic score for diagnosing arginine vasopressin deficiency (central diabetes insipidus) or primary polydipsia with basal laboratory and clinical parameters: results from two international multicentre prospective diagnostic studies. Lancet Diabetes Endocrinol. Published 25 April 2025. doi:10.
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