Objective To investigate the risk factors for Kawasaki disease（KD） comorbid with coronary artery lesion（CAL） by analyzing the clinical features and laboratory markers of children with KD. Methods A total of 346 children with KD who were hospitalized for treatment from June 2023 to June 2024 were enrolled as subjects，among whom there were 134 children from The First People’s Hospital of Zunyi and 212 children from Children’s Hospital of Chongqing Medical University. According to the presence or absence of CAL，the children were divided into KD group with CAL（KD-CAL group） and KD group without CAL（KD-NCAL group）. A difference analysis，a collinearity analysis，and the multivariate logistic regression analysis were performed for the clinical features and laboratory markers of the two groups. Results There were no significant differences between the KD-CAL group and the KD-NCAL group in age，time of intravenous immunoglobulin shock therapy，rash，lip changes，bulbar conjunctival hyperemia，peripheral changes of limbs，white blood cell count，hemoglobin，percentage of neutrophils，platelet count，C-reactive protein，erythrocyte sedimentation rate，alanine aminotransferase，and blood sodium（P>0.05），while there were significant differences between the two groups in sex，cervical lymphadenectasis，procalcitonin（PCT），and albumin（ALB）（P<0.05）. The subsequent multivariate logistic regression analysis showed that male sex（odds ratio［OR］=1.886，95%CI=1.198-2.971，P=0.006），ALB（OR=0.938，95%CI=0.894-0.983，P=0.008），and PCT（OR=1.107，95%CI=1.007-1.207，P=0.035） were independently associated with the presence of CAL in patients with KD. Conclusion Male sex，low ALB，and high PCT are independent risk factors for CAL in children with KD，and for such children，early intervention should be actively performed to avoid CAL.