OBJECTIVE: To investigate the levels of serum ferritin (SF), human neutrophil lipocalin (HNL), procalcitonin (PCT), and inflammatory cytokines (IL-6, IL-10, IL-17, IL-18, TNF-α, INF-γ, and sCD25) in Kawasaki disease (KD) and their relationship with coronary artery lesions (CAL). METHODS: A retrospective analysis was conducted on 76 children with KD treated from May 2022 to May 2024. Participants were classified into a lesion group (n=48) and a no-lesion group (n=28) based on CAL status. Additionally, 76 healthy children were included as controls. Patients with CAL were further categorized into three subgroups based on coronary artery dilation: mild dilation (n=21), moderate dilation (n=18) and coronary artery aneurysm (n=9). The correlation between indicator levels and CAL severity, as well as coronary artery diameter at admission, was analyzed. Partial regression was used to identify inflammatory factors associated with CAL. RESULTS: The lesion group showed significantly higher levels of serum SF, HNL, PCT, and all seven inflammatory cytokines at admission compared to the no-lesion and control groups (all P<
0.05). Among patients with CAL, those with coronary artery aneurysms exhibited the highest levels of these indicators compared to the moderate dilation subgroup (P<
0.05). Serum levels of SF, HNL, PCT, and inflammatory cytokines were positively correlated with CAL severity and coronary artery diameter. Logistic regression analysis identified these markers as risk factors for CAL in KD. The area under the curve (AUC) for IL-18 was 0.891, with a sensitivity of 0.643 and a specificity of 0.042. CONCLUSIONS: Serum SF, HNL, PCT, IL-17, IL-18, and TNF-α are implicated in CAL development in children with KD and may assist in the early clinical diagnosis of CAL.