Introduction

Multisystem inflammatory syndrome (MIS-C) is a rare paediatric hyper-inflammatory disorder that occurs following SARS-CoV-2 infection. Acute kidney injury (AKI) occurs in approximately one-quarter to one-third of the patients with MIS-C and is associated with poor prognosis in critically ill children. This systematic review is aimed to evaluate the incidence of AKI, mortality, and the need for kidney replacement therapy (KRT) in patients with MIS-C.

Methods

We searched databases from Medline, EMBASE, Cochrane Register, and Google Scholar from December 2019 to December 2021 with our search strategy. Studies meeting the following criteria were included in this systematic review: (1) articles on AKI in MIS-C; (2) studies providing AKI in MIS-C and COVID-19 infection separately; (3) studies reporting outcomes such as mortality, KRT, serum creatinine; length of hospital/ICU stay.

Quality assessment

The quality of the included studies was independently assessed by using the National Heart Lung and Blood Institute (NHLBI) quality assessment tool for cohort studies and case series.

Statistical analysis

Outcomes and their 95% confidence intervals (CI) were reported if a meta-analysis of these outcomes was conducted. Heterogeneity was reported using I² statistics, and heterogeneity ≥ 50% was considered high. We used Baujat’s plot for the contribution of each study toward overall heterogeneity. In sensitivity analysis, the summary estimates were assessed by repeating meta-analysis after omitting one study at a time. Forest plots were used for reporting outcomes in each study and with their 95% CI. All statistical tests were performed using R software version 4.0.3.

Results

 A total of 24 studies were included in this systematic review and of these, 11 were included in the meta-analysis. The pooled proportion of patients with MIS-C developing AKI was 20% (95% CI: 14–28%, I² = 80%). Pooled proportion of death in children with MIS-C was 4% (95% CI: 1–14%; I² = 93%). The odds of death in patients with AKI were 4.68 times higher than in patients without AKI (95% CI: 1.06–20.7%; I² = 17%). The overall pooled proportion of MIS-C-induced AKI patients requiring KRT was 15% (95% CI: 4–42%; I² = 91%).

Conclusion

Approximately one-fifth of children with MIS-C develop AKI which is associated with higher odds of death.

PROSPERO registration: CRD42022306170

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

中文翻译：

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儿童 SARS-CoV-2 感染相关多系统炎症综合征后的急性肾损伤：系统评价和荟萃分析

介绍

多系统炎症综合征 (MIS-C) 是一种罕见的儿科高炎症性疾病，发生在 SARS-CoV-2 感染后。急性肾损伤 (AKI) 发生在大约四分之一到三分之一的 MIS-C 患者中，并且与危重儿童的不良预后相关。本系统评价旨在评估 MIS-C 患者的 AKI 发生率、死亡率和肾脏替代治疗 (KRT) 的必要性。

方法

我们使用我们的搜索策略搜索了 2019 年 12 月至 2021 年 12 月的 Medline、EMBASE、Cochrane Register 和 Google Scholar 的数据库。符合以下标准的研究被纳入该系统评价：(1) MIS-C 中关于 AKI 的文章；(2) 分别在 MIS-C 和 COVID-19 感染中提供 AKI 的研究；(3) 报告死亡率、KRT、血清肌酐等结果的研究；住院时间/ICU 住院时间。

质量评估

纳入研究的质量通过使用国家心肺血液研究所 (NHLBI) 队列研究和病例系列的质量评估工具进行独立评估。

统计分析

如果对这些结果进行荟萃分析，则报告结果及其 95% 置信区间 (CI)。使用I ²统计报告异质性，异质性 ≥ 50% 被认为是高的。我们使用 Baujat 的图来表示每项研究对整体异质性的贡献。在敏感性分析中，通过一次省略一项研究后重复荟萃分析来评估汇总估计值。森林图用于报告每项研究的结果及其 95% CI。所有统计测试均使用 R 软件版本 4.0.3 进行。

结果

 本系统评价共纳入 24 项研究，其中 11 项纳入荟萃分析。MIS-C 患者发生 AKI 的合并比例为 20%（95% CI：14–28%，I ² = 80%）。MIS-C 儿童的合并死亡比例为 4%（95% CI：1–14%；I ² = 93%）。AKI 患者的死亡几率是无 AKI 患者的 4.68 倍（95% CI：1.06–20.7%；I ² = 17%）。需要 KRT 的 MIS-C 诱发的 AKI 患者的总体汇总比例为 15%（95% CI：4–42%；I ² = 91%）。

结论

大约五分之一患有 MIS-C 的儿童会发展为 AKI，这与较高的死亡率有关。

PROSPERO注册号：CRD42022306170

图形概要

图形摘要的更高分辨率版本可作为补充信息使用