Objective: To assess macrophage activation syndrome (MAS) in septic shock leading to multiorgandysfunction syndrome (MODS).Methods: A prospective observational study was conducted at a tertiary care hospital to evaluate theMAS criteria in different stages of sepsis. Children aged 6 months to 12 years in different stages of septic shock were recruited. The Paediatric Rheumatology International Trials Organisation CollaborativeInitiative (PRINTO) criteria of MAS were applied initially at the stage of septic shock and subsequentlyat the stage of MODS (MODS cohort) or following recovery from septic shock without going throughMODS (non-MODS cohort).Results: A total of 127 subjects were studied, with 53 comprising the MODS cohort and the rest 74 thenon-MODS cohort. At the initial assessment, a comparable proportion of subjects in the MODS andnon-MODS groups satisfied the MAS criteria (20.75% and 25.68%, respectively; p=0.529). However,by the time of progression to MODS, 81.13% of the subjects satisfied the MAS criteria in the MODSgroup, whereas only 16.18% subjects in the non-MODS group continued to satisfy the MAS criteria(p<0.001). Thus, there was a definite increase in the proportion of subjects showing MAS by the timethey progressed to multiorgan dysfunction (p<0.001). In contrast, the proportion declined significantly (25.68% to 16.18%; p=0.008) in the subjects who had recovered.Conclusion: The findings bear out the hypothesis that MODS in sepsis is a reflection of MAS secondaryto sepsis. However, studies in larger cohorts are needed to validate these findings and explore thetherapeutic implications.