Associations of Preoperative HMGB-1 and Systemic Immune-Inflammation Index with Short-Term Behavioral Improvement...

To explore the association of High-Mobility Group Box-1 (HMGB-1) with behavioral improvement after obstructive sleep apnea-hypopnea syndrome (OSAHS) surgery in children during short-term follow-up.

In this prospective observational cohort study, 138 children with OSAHS who underwent bilateral tonsillectomy and adenoidectomy were enrolled between December 2024 and June 2025. Preoperative levels of HMGB-1 and the Systemic Immune-Inflammation Index (SII) were measured. The Rutter Behavior Scale was assessed 1 day before surgery and 30 days after surgery. Patients were classified into three groups: markedly effective, effective, and ineffective. Associations between HMGB-1, SII, and behavioral improvement were assessed using Spearman rank correlation. Mediation analysis evaluated whether SII is associated with behavioral change. ROC curves assessed the discrimination of HMGB-1 and SII for postoperative behavioral improvement.

Of the 138 children initially enrolled, 112 completed follow-up and were classified by therapeutic efficacy: markedly effective (n = 37), effective (n = 40), and ineffective (n = 35). Postoperative Rutter scores significantly decreased in the markedly effective and effective groups (both P < 0.05) but not in the ineffective group (P = 0.066). Preoperative HMGB-1 and SII levels were highest in the ineffective group, intermediate in the effective group, and lowest in the markedly effective group (P < 0.05). Ordered logistic regression identified preoperative HMGB-1 (OR 2.91, 95% CI 1.89~4.48, P < 0.05), SII (OR 1.01, 95% CI 1.00~1.01, P < 0.05), and baseline Rutter score (OR 0.67, 95% CI 0.54~0.81, P < 0.05) as significant independent predictors of behavioral improvement. The degree of postoperative behavior improvement was negatively correlated with serum HMGB-1 and SII levels. Mediation analysis showed that SII mediated 13.1% of HMGB-1's total effect (indirect effect -0.129, 95% CI -0.247 to -0.035). ROC curves indicated strong predictive performance for HMGB-1 (AUC 0.890) and SII (AUC 0.794).

Elevated preoperative serum HMGB-1 levels were independently associated with reduced postoperative behavioral improvement in children with OSAHS, and this relationship showed a pattern consistent with partial mediation by SII levels, compatible with the hypothesis of systemic inflammatory pathway involvement. These findings provide preliminary evidence that preoperative inflammatory biomarkers may help identify high-risk children for closer monitoring during short-term recovery, though causal mechanisms require further validation in interventional studies.