Elevated Urinary Leukotriene E₄ Levels Are Associated with Hospitalization for Pain in Children with Sickle Cell Disease.

Introduction: Sickle cell disease (SCD) is associated with an inflammatory state. Luekotrienes are inflammatory mediators derived from arachidonic acid and produced by white blood cells in response to inflammatory stimuli. We tested two hypotheses among children with SCD:

1. Baseline leukotriene levels are elevated in SCD when compared to controls children without SCD,

2. Baseline leukotriene levels are associated with an increased incidence rate of hospitalization for pain.

Methods: During routine clinical visits, baseline urinary leukotriene E₄ (LTE₄) levels were measured in children with SCD (cases) and age, and ethnic, matched children without SCD (controls). Medical records of the cases were reviewed to assess the frequency of hospitalization for pain within three years of entering the study.

Results: LTE₄ levels were obtained in 71 cases and 22 controls. LTE₄ levels were higher in the cases compared to controls (median LTE₄: 100 vs.57 pg/mg creatinine); P < 0.001. After adjustment for age and diagnosis of asthma, a greater incidence rate of hospitalization for pain was observed among children with SCD in the highest tertile group when compared to the lowest tertile group (114 vs. 52 episodes per 100 patient-years, P=0.038).

Conclusion: LTE₄ levels are elevated in children with SCD when compared to controls without SCD and are associated with an increased rate of hospitalizations for pain.