Associations of Preoperative HMGB-1 and Systemic Immune-Inflammation Index with Short-Term Behavioral Improvement After Adenotonsillectomy in Children with OSAHS.

Objective: 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. Methods: 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. Results: 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 Conclusion: 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.