Elevated urinary leukotriene E₄ levels are associated with hospitalization for pain in children with sickle cell disease

Cysteinyl leukotrienes (CsyLTs) are inflammatory mediators produced by white blood cells. Leukotriene LTE₄ is the stable metabolite of CsyLTs, which can be measured in urine. We tested two hypotheses among children with sickle cell disease (SCD): (1) baseline urinary LTE₄ levels are elevated in children with SCD when compared with controls; and (2) baseline LTE₄ levels are associated with an increased incidence rate of hospitalization for SCD-related pain. Baseline LTE₄ levels were measured in children with SCD (cases) and children without SCD matched for age and ethnicity (controls). Medical records of cases were reviewed to assess the frequency of hospitalization for pain within 3 years of study entry. LTE ₄ levels were obtained in 71 cases and 22 controls. LTE₄ levels were higher in cases compared with controls (median LTE₄: 100 vs. 57 pg/mg creatinine, P < 0.001). After adjustment for age and asthma diagnosis, a greater incidence rate of hospitalization for pain was observed among children with SCD in the highest LTE₄ tertile when compared with the lowest (114 vs. 52 episodes per 100 patient-years, P = 0.038). LTE ₄ levels are elevated in children with SCD when compared with controls. LTE₄ levels are associated with an increased rate of hospitalizations for pain.