Diagnostic Accuracy of Copeptin in the Differential Diagnosis of the Polyuria-polydipsia Syndrome: A Prospective Multicenter Study

CONTEXT The polyuria-polydipsia syndrome comprises primary polydipsia (PP) and central and nephrogenic diabetes insipidus (DI). Correctly discriminating these entities is mandatory, given that inadequate treatment causes serious complications. The diagnostic "gold standard" is the water deprivation test with assessment of arginine vasopressin (AVP) activity. However, test interpretation and AVP measurement are challenging. OBJECTIVE The objective was to evaluate the accuracy of copeptin, a stable peptide stoichiometrically cosecreted with AVP, in the differential diagnosis of polyuria-polydipsia syndrome. DESIGN, SETTING, AND PATIENTS This was a prospective multicenter observational cohort study from four Swiss or German tertiary referral centers of adults >18 years old with the history of polyuria and polydipsia. MEASUREMENTS A standardized combined water deprivation/3% saline infusion test was performed and terminated when serum sodium exceeded 147 mmol/L. Circulating copeptin and AVP levels were measured regularly throughout the test. Final diagnosis was based on the water deprivation/saline infusion test results, clinical information, and the treatment response. RESULTS Fifty-five patients were enrolled (11 with complete central DI, 16 with partial central DI, 18 with PP, and 10 with nephrogenic DI). Without prior thirsting, a single baseline copeptin level >21.4 pmol/L differentiated nephrogenic DI from other etiologies with a 100% sensitivity and specificity, rendering a water deprivation testing unnecessary in such cases. A stimulated copeptin >4.9 pmol/L (at sodium levels >147 mmol/L) differentiated between patients with PP and patients with partial central DI with a 94.0% specificity and a 94.4% sensitivity. A stimulated AVP >1.8 pg/mL differentiated between the same categories with a 93.0% specificity and a 83.0% sensitivity. LIMITATION This study was limited by incorporation bias from including AVP levels as a diagnostic criterion. CONCLUSION Copeptin is a promising new tool in the differential diagnosis of the polyuria-polydipsia syndrome, and a valid surrogate marker for AVP. Primary Funding Sources: Swiss National Science Foundation, University of Basel.

Notebook describing scholars' and church fathers' accounts of the Resurrection, undated

This notebook contains prose entries about many different scholars' accounts of Jesus Christ's Resurrection. Prince apparently studied over fifty authors' writings concerning the Resurrection and recorded in this notebook what he considered to be the significant details of each authors' interpretation.

Sundry extracts on the subject of the taxation of College &c., ca. 1798-1801

Notebook with brown paper cover containing handwritten extracts from the charters and related legislation of New England academic, charitable, and commercial institutions regarding their ability to hold real estate and related tax exemptions. Most of the listed documents are dated in the 1780s and 1790s. The notebook also contains extracts from "Argument in the case of Poor's rate, charged on the College of Christ & Emmanuel in the University of Cambridge 1768." The item title is transcribed from a handwritten inscription on the back cover.

Selections from the world's greatest short stories; illustrative of the history of short story writing;

Patient Griselda, from the "Decameron" of Boccaccio. Rewritten in English by the editor.--Aladdin, or The wonderful lamp, from "The Arabian nights".--Rip Van Winkle, by Washington Irving.--A passion in the desert, by Honoré de Balzac. Rewritten in English by the editor.--A child's dream of a star, by Charles Dickens.--A Christmas carol, by Charles Dickens.--A princess's tragedy, from "Barry Lyndon", by W.M. Thackeray.--The gold-bug, by Edgar Allan Poe.--The great stone face, by Nathaniel Hawthorne.--The necklace, and The string, by Guy de Maupassant. Rewritten in English by the editor.--The man who would be king, by Ruyard Kipling.--How Gavin Birse put it to Mag Lownie, from "A window in Thrums", by J.M. Barrie.--On the stairs, from "Tales of mean streets", by Arthur Morrison.

Jesus before Pilate; a monograph of the crucifixion; political and legal history of the trial of Jesus under the Jewish and Roman criminal law, with an account of the office, powers, public acts and private character of Tiberius Caesar ... and others connected with the trial; embracing the Acts of Pontius Pilate, translatd from the oldest manuscripts, with proof of their antiquity and discussion of authenticity;

Disbound Original Held in Oak Street Library Facility.

Saint Christopher Carrying the Christ Child

Limbourg Brothers; 8 7/64 in.x 5 55/64 in.; ink on vellum

The Virgin and Child,center, left wing, Visitation, the Annunciation and the Adoration of the Magi, right wing, Nativity, and the Presentation in the Temple

8 13/16 in.x 6 3/8 in.x 53/64 in.; elephang ivory

The Death and Coronation of the Virgin: Coronation

W: 4 11/64 in.; carved elephant ivory, painted and gilded

The significance of the teaching of Jesus,

Mode of access: Internet.

A Year book of the church and social service in the United States.

Includes bibliographies.

Calvin's doctrine of the Word and sacrament

Bibliographical footnotes

A Letter on the Latter-day work of the Lord,

In double columns.

The Holy Bible : containing the Old and New Testaments : the text is carefully printed from the most correct copies of the present authorized translation, including the marginal readings and parallel texts /

Vols. [6-8], published in 1817, have title: The New Testament, of our Lord and Saviour Jesus Christ, and are numbered v. 1-3.

A series of plays : in which it is attempted to delineate the stronger passions of the mind /

"Each passion being the subject of a tragedy and a comedy."