Leukotriene E 4 (LTE 4 ) levels are associated with rate of pain episodes in children with sickle cell disease (SCD). Because complications of SCD manifest differently in adults than children, we examined a cohort of adults with SCD to determine the relationship between baseline LTE 4 and SCD-related morbidity. Baseline LTE 4 levels were associated with increased rates of pain and acute chest syndrome (ACS) episodes, when those with LTE 4 values in the highest tertile were compared with those in the lowest tertile (pain: risk ratio 7.1, 95% CI 1.8-27.5, P 5 0.005; ACS: risk ratio 12.2, 95% CI 2.1-69.8, P 5 0.005). Am. J. Hematol. 84:158-160, 2009. V