Background: Kawasaki disease (KD) is one of the leading causes of acquired coronary artery diseases in childhood. In KD patients, the evidence on the association between easy-to-assess clinical risk factors and development of coronary artery lesion (CAL). Our study aimed to determine the clinical biomarkers that were associated with latent occurrence of CAL in pediatric patients with KD. Methods: 260 pediatric KD patients were recruited. The outcome of our study is CAL, including coronary dilation, coronary aneurysm, and intimal thickening of coronary arteries. Data of general information, medical history, results of laboratory examinations and echocardiography data were collected. Logistic regression method was carried out to explore the associations between biomarkers and each CAL. Results: Sixty-six (25.4 %), thirty-nine (15 %) and fifty-six patients (21.5 %) of the participants had coronary dilation, coronary aneurysm, and intimal thickening of coronary arteries, respectively. Single-variable analysis found age, gender, duration of fever, time of initial use of IVIG, ESR, WBC, time of platelet increase, maximum value of platelet, albumin and IgG level were associated with CAL. In multivariable logistic analysis, younger in age and male were associated with all three outcomes of CAL. Lower serum albumin level and later initial use of IVIG were linked to higher risk of coronary dilation and coronary aneurysm.Conclusion: In a Chinese pediatric population of KD, younger in age, male, lower serum albumin lever, and later initial use of IVIG were risk factors of CAL. Our findings had high practicability to be implemented in clinical practice, however, is to be verified by future studies.