Prognostic value of the Osaka Prognostic Score for two-year mortality in patients with heart failure with reduced ejection fraction

Background Heart failure with reduced ejection fraction (HFrEF) is associated with substantial morbidity and mortality, highlighting the need for simple and reliable prognostic tools. The Osaka Prognostic Score (OPS), an inflammation- and nutrition-based score incorporating C-reactive protein (CRP), serum albumin, and lymphocyte count, has demonstrated prognostic value in several cardiovascular conditions. However, its significance in patients with HFrEF remains unclear. This study investigated the association between OPS and two-year all-cause mortality in patients with HFrEF. Methods This retrospective single-center study included 198 patients with HFrEF. OPS was calculated using serum CRP, albumin, and total lymphocyte count obtained at baseline. The primary outcome was two-year all-cause mortality. Survival was evaluated using Kaplan–Meier analysis. Independent predictors of mortality were identified using Cox proportional hazards regression. Receiver operating characteristic (ROC) analysis and DeLong testing were performed to compare the predictive performance of OPS and its individual components. Results During the two-year follow-up, 42 patients (21.2%) died. Non-survivors had significantly higher OPS values than survivors (2 [1–2] vs. 0 [0–1], p < 0.001). Kaplan–Meier analysis demonstrated progressively reduced survival across increasing OPS categories (log-rank p < 0.001). In multivariable Cox regression analysis, diabetes mellitus (adjusted hazard ratio [aHR] 2.67, 95% CI 1.28–5.57; p = 0.009) and OPS (aHR 2.63, 95% CI 1.86–3.73; p < 0.001) were independent predictors of two-year mortality. ROC analysis showed that OPS had the highest discriminative ability for mortality prediction (AUC 0.824), outperforming lymphocyte count ( p = 0.005) and demonstrating comparable performance to CRP and albumin ( p = 0.828 and p = 0.057). Conclusion OPS was independently associated with two-year mortality and demonstrated good prognostic performance in patients with HFrEF. As a readily available score integrating inflammatory, nutritional, and immunological parameters, OPS may represent a useful prognostic marker in this population. Prospective multicenter studies are warranted to validate these findings.