Abstract: Objective To evaluate the significance of DeRitis ratio and other biochemical markers in evaluating coronary artery lesions (CAL) in children with typical Kawasaki disease (KD). 
Methods A total of 96 children with KD who were treated at Hebei Children′s Hospital from June 2022 to June 2024 were enrolled. Based on echocardiographic findings, patients were divided into two groups: the CAL+ group (with CAL complications, n=35) and the CAL- group (without CAL complications, n=61). The CAL+ group was further subdivided into patients whose coronary arteries recovered within 8 weeks of treatment (n=23) and those with persistent coronary artery dilation after 8 weeks (n=12). Peripheral venous blood samples were collected under fasting conditions during the acute phase of KD, clinical recovery phase, and at 8 weeks after intravenous immunoglobulin (IVIG) treatment. Liver function, myocardial enzyme profiles, and serum electrolytes were measured, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), lactate dehydrogenase (LDH), and serum sodium levels. DeRitis ratio and LDH/AST ratio were calculated, and statistical analyses were performed. 
Results ①During the acute phase of KD, the CAL+ group showed significantly higher DeRitis ratio compared with the CAL- group (1.74±0.68 vs. 1.16±0.32 vs. 0.76±0.24, F=26.858, P＜0.001). Furthermore, the DeRitis ratio in the CAL+ persistent dilation subgroup was higher than that in the CAL+ recovery subgroup (1.74±0.68 vs. 1.16±0.32, t=3.376, P=0.002), with both differences being statistically significant. ② At 8 weeks after IVIG treatment, the CAL+ persistent dilation subgroup exhibited a significantly higher DeRitis ratio compared with the CAL+ recovery subgroup (1.86±0.42 vs. 1.23±0.36, t=4.871, P＜0.001), indicating a significant difference. 
Conclusion The DeRitis ratio and related biochemical markers are sensitive indicators for predicting the occurrence of CAL during the acute phase of typical KD. They also provide early prognostic insights into short-term outcomes in KD patients with CAL. 

Key words: mucocutaneous lymph node syndrome, coronary artery, DeRitis ratio