Aim The SARS‐CoV‐2 pandemic is characterised by multiple reports of paediatric multisystem inflammatory disease or multisystem inflammatory syndrome in children (MIS‐C) with Kawasaki disease‐like features often complicated by myocarditis, shock and macrophage activation syndrome. Certain clinical and laboratory markers may be used to identify high risk cases. Methods All sequentially admitted patients hospitalised between April 2020 and October 2020, who met the WHO case definition for MIS‐C were included. Data included patient demographic information, presenting symptoms, organ dysfunction and laboratory parameters. SARS‐CoV‐2 infection was diagnosed by nasopharyngeal swab real‐time reverse transcription‐polymerase chain reaction and/or rapid antibody test for SARS‐CoV‐2 as recommended. The clinical and laboratory criteria were compared in the survival and non‐survival groups. Results A total of 29 patients with MIS‐C were treated during the study period. There were 21 survivors and 8 non‐survivors. The non‐survivors had more neurocognitive and respiratory symptoms along with increased incidence of myocarditis compared with survivors. The serum levels of CPK‐MB, D‐dimer, ferritin and triglyceride were significantly raised in non‐survivors as compared to survivors. Conclusion The non‐survivor group had higher CPK and greater proportion of children with troponin‐T elevation indicating higher incidence of myocardial injury and necrosis. The D‐dimer, ferritin and triglyceride were also higher in the mortality group, indicating the greater extent of inflammatory damage in this group.

Background Acute kidney injury (AKI) has been recognized as a significant risk factor for mortality among adults with severe acute respiratory syndrome coronavirus infection. Aim The aim of this study is to assess the prevalence and risk factors for AKI and mortality in children with coronavirus disease 2019 (COVID19) from a resource-limited setting. Methods Cross-sectional analysis of laboratory confirmed COVID19 children admitted from 1 March to 30 November 2020 in a tertiary care hospital in New Delhi, India was done. Clinical features and associated comorbidities of COVID19 were noted. Baseline serum creatinine (height-independent Hoste’s equation) and peak serum creatinine were used for staging of AKI by the 2012 Kidney Disease Improving Global Outcomes serum creatinine criteria. Univariate analysis and Kaplan–Meier survival analysis were used to compare the overall outcome in the AKI vs. the non-AKI group. Results A total of 64 810 children between 1 month and 18 years visited the hospital; 3412 were tested for suspected COVID19, 295 tested positive and 105 (54% boys) were hospitalized. Twenty-four hospitalized children (22.8%) developed AKI; 8 in Stage 1 (33.3%), 7 in Stage 2 (29.2%) and 9 in Stage 3 (37.5%) respectively. Overall, three patients received KRT. Highest reported mortality was (66.6%) in AKI Stage 3. Risk factors for AKI included associated sepsis (OR 95% CI, 1.22-9.43, p < 0.01), nephrotic syndrome (OR 95% CI, 1.13-115.5, p < 0.01), vasopressor support (OR 3.59, 95% CI, 1.37–9.40, p value< 0.007), shock at presentation (OR 2.98, 95% CI, 1.16–7.60, p value 0.01) and mechanical ventilation (OR 2.64, 95% CI, 1.04–6.71, p value< 0.03). Mortality (25.71%) was higher in the AKI group (OR 95% CI, 1.14-8.35, p < 0.023) with shock (OR 45.92; 95% CI, 3.44–612.0, p value <0.004) and ventilation (OR 46.24; 95% CI, 1.6–1333.0 p value< 0.02) as significant risk factors for mortality. Conclusion AKI is an important modifiable risk factor for mortality in children with COVID19 in a resource-limited setting. Our study supports the strengthening of kidney replacement therapy and its timely initiation to reduce the progression of AKI and thus mortality in children.

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