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Jiarun Qin,1 Jialei Zhang,1 Mengyuan Ge,2 Dacheng Gu,2 Yifan Liu,3 Jianing Bo,3 Kai Shen,2 Jiangbo Qin,2 Xiaoyan Ma3 1Department of Pain Treatment, Changzhi Peopleâs Hospital Affiliated to Changzhi Medical College, Changzhi, Peopleâs Republic of China; 2Department of Otolaryngology, Changzhi Peopleâs Hospital Affiliated to Changzhi Medical College, Changzhi, Peopleâs Republic of China; 3Department of Anesthesiology, Changzhi Peopleâs Hospital Affiliated to Changzhi Medical College, Changzhi, Peopleâs Republic of ChinaCorrespondence: Jiangbo Qin, Email 1053536008@qq.com Xiaoyan Ma, Email 66846396@qq.comObjective: 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 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-1âs total effect (indirect effect â 0.129, 95% CI â 0.247 to â 0.035). ROC curves indicated strong predictive performance for HMGB-1 (AUC 0.890) and SII (AUC 0.794).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.Keywords: high-mobility group box-1, systemic immune-inflammation index, pediatric obstructive sleep apnea-hypopnea syndrome, mediation effect, behavioral improvement
Qin et al. (Fri,) studied this question.