OBJECTIVE: Kawasaki disease (KD) is a systemic vasculitis, and oxidative stress and systemic inflammation are the possible pathogenesis. The elevated gammaglutamyl transpeptidase (GGT) is closely related to oxidative stress and the markers of systemic inflammation. We focused on the baseline data of GGT in KD patients and analyzed the relationship between GGT variation and the risk of coronary artery injury in KD. STUDY DESIGN: KD patients of Children's Hospital of Soochow University during March 1, 2016, to April 30, 2020, were used in this retrospective study. The patients were divided into high and low GGT groups according to the median of GGT (M=21.8). We compared the differences in laboratory characteristics between groups and analyzed the risk factors of coronary artery abnormalities. RESULTS: A total of 1,293 patients were included in this study. After being grouped according to the 2 classifications of GGT, the high GGT group showed more cases of coronary artery abnormalities and higher GGT, ALT, TBIL, and neutrophil ratio (all p<0.05). Meanwhile, patients with high GGT showed higher immune status, and elevated GGT was a risk factor for coronary artery damage in KD (OR 1.008, 95% CI 1.006-1.010, p<0.001), together with total bilirubin (OR 0.964, 95% CI 0.964-0.981, p<0.001), CRP (OR 1.003, 95% CI 1.001-1.006, p=0.01), and Hgb (OR 0.985, 95% CI 0.973-0.997, p=0.017). CONCLUSION: In this study, high GGT was a risk factor for coronary artery damage in KD. Therefore, clinicians should pay attention to the level of GGT. It is necessary to increase the frequency of follow-up, strengthen the education of parents, and carefully check echocardiograms in cases of KD with elevated GGT. © Science Printers and Publishers, Inc.