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Objective: To investigate the value of electrocardiogram QT interval dispersion (QTd) combined with 25-hydroxyvitamin D [25-(OH) D], growth differentiation factor-15 (GDF-15) and pentraxin 3 (PTX3) in the evaluation of coronary artery lesions (CAL) in children with Kawasaki disease. Methods: 180 children with Kawasaki disease admitted to our hospital from June 2018 to June 2023 were selected, and patients were divided into CAL group (36 cases) and non-CAL group (144 cases) according to whether CAL occurred. All children received electrocardiogram examination to obtain QTd and corrected QT dispersion (QTcd), and serum 25-(OH)D, GDF-15 and PTX3 levels were detected. The factors affecting the occurrence of CAL in children with Kawasaki disease were analyzed by multivariate Logistic regression analysis, and a Log P model of multi-index combined application was constructed. The predictive value of QTd, 25-(OH)D, GDF-15 and PTX3 for CAL in children with Kawasaki disease were analyzed by receiver operating characteristic (ROC) curve. Results: The levels of QTd, QTcd, GDF-15 and PTX3 in CAL group were higher than those in non-CAL group (P<0.05), and the level of 25-(OH)D was lower than that in non-CAL group(P<0.05). Treatment non-response, high QTd, high QTcd, high GDF-15, and high PTX3 were risk factors for CAL in children with Kawasaki disease (P<0.05), and high 25-(OH)D was a protective factor (P<0.05). The Log P models of multi-index combined application were constructed as follows: A: electrocardiogram parameter model: Ln (P/1-P)=0.512 ×QTd+0.596 QTcd; B: serum 3 index model: Ln (P/1-P)=0.712×GDF-15+0.626×PTX3-0.609×25- (OH)D; C: 5-factor joint application model (above A+B model): Ln (P/1-P)=0.512×QTd+0.596 QTcd+0.712×GDF-15+0.626×PTX3-0.609×25-(OH)D. ROC analysis showed that, models A, B and C had certain predictive efficacy for CAL in children with Kawasaki disease, and their ROC-AUC (0.95CI) were 0.709 (0.490~0.921), 0.787 (0.579~0.966) and 0.835 (0.699~0.955) respectively. C combined application model has the highest prediction efficiency. Conclusion: The QTd increase, QTcd increased, GDF-15 increase, PTX3 increase, and 25-(OH)D decrease in children with Kawasaki disease with CAL, the combined detection of the above indicators has a high predictive efficiency for the occurrence of CAL in children with Kawasaki disease. [ABSTRACT FROM AUTHOR]