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while medical evaluation and criticism should also be considered&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Both scores have been used for screening of sepsis&#44; but the evaluation of these scores in the prediction of mortality can be useful because approach to patients with higher mortality risk can be differentiated&#46; Even though several scores have been well established&#44; an individualized prognostic model on the basis of the nomogram could accurately predict mortality and optimize management or tailored therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The SIRS&#44; qSOFA&#44; and pSOFA &#40;pediatric&#41; have been used in previous studies as a predictive model of mortality in pediatric population&#44; pregnant and adult hematological patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;12</span></a> These predictive models can be used for alert systems&#44; improving the approach of patient care&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We hypothesized that these scores and comorbidities can be used to predict mortality&#46; In this study&#44; we aimed to develop of a mortality risk score based on qSOFA&#44; SIRS&#44; and comorbidities&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective cohort study of patients included in the sepsis protocol in two Brazilian university hospitals&#46; This study was approved with a waiver of informed consent by the institutional review board of the Pontif&#237;cia Universidade Cat&#243;lica do Paran&#225; &#40;CAAE number&#58; 79976517&#46;4&#46;0000&#46;0020&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Settings</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study was conducted on adult patients with suspected sepsis&#46; The cohort included patients admitted at two academic public hospitals between January 2016 and December 2021&#46; The first hospital was composed of an emergency room&#44; a 207-bed hospital ward&#44; and a 29-bed mixed intensive care unit &#40;ICU&#41;&#44; but reference for trauma&#44; neurosurgery&#44; and general surgery&#46; The second hospital was also composed of an emergency room&#44; 240-bed hospital wards&#44; and a 38-bed ICU&#44; reference for general surgery and cardiovascular surgery&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Both hospitals present the same antimicrobial stewardship team&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Sepsis protocol</span><p id="par0040" class="elsevierStylePara elsevierViewall">The antibiotic therapy decisions were based on local microbial resistance profiles&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The antibiotic stewardship program &#40;ASP&#41; implemented a restrictive policy for dispensing carbapenems and polymyxin using a hand-filled form&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> In addition&#44; a prospective auditing and feedback process was adopted for all antimicrobial prescriptions&#46; Dose&#44; length of treatment adjustment&#44; de-escalation&#44; route of administration&#44; and side effects were determined under the guidance of a clinical pharmacist and infectious diseases specialist&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Once sepsis was suspected and judged that antimicrobial therapy was needed in the first hour&#44; the physician fulfilled the protocol&#46; However&#44; only those with Sepsis-3 criteria were included&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> which was defined within 24&#8239;hours by the antimicrobial stewardship&#46; The patients were followed up until death or discharge&#46; The hour-1 bundle includes&#58; i&#41; measuring lactate level and remeasuring lactate if initial lactate is elevated &#40;&#62; 2&#8239;mmol&#47;L&#41;&#59; ii&#41; obtaining blood cultures before administering antibiotics&#59; iii&#41; administration of broad-spectrum antibiotics&#59; iv&#41; rapid administration of 30&#8239;mL&#47;kg crystalloid for hypotension or lactate &#8805; 4&#8239;mmol&#47;L&#59; v&#41; application of vasopressors if the patient was hypotensive during or after fluid resuscitation to maintain a mean arterial pressure &#8805;65&#8239;mmHg&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The sepsis bundle is shown in Supplementary Figure 1 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Participants</span><p id="par0050" class="elsevierStylePara elsevierViewall">Inclusion criteria were &#40;i&#41; a hospital admission&#44; &#40;ii&#41; &#8805;18 years of age&#44; and &#40;iii&#41; a starting sepsis protocol&#44; &#40;iv&#41; sepsis diagnosis according to Sepsis-3 criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The only exclusion criterion was a lack of information in the patient&#8217;s sepsis protocol file to avoid selection bias&#46; Follow-up was performed using electronic medical records&#46; Patients with more than one episode of sepsis were included as a &#8220;new&#8221; event&#46; The population of the study included ICU&#44; ward&#44; and emergency room&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Variables</span><p id="par0055" class="elsevierStylePara elsevierViewall">The SIRS &#40;2 points&#41; and qSOFA &#40;2 points&#41;&#44; as well as other clinical data were considered at the moment of protocol&#46; The SIRS criteria &#40;i&#46;e&#46;&#44; temperature &#62; 38&#8239;&#176;C&#44; heart rate &#62;90&#47;min&#44; respiratory rate &#62;20&#47;min&#44; and leukocytes &#62;12&#44;000 or &#60;4&#44;000 cell&#47;mm<span class="elsevierStyleSup">3</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and qSOFA score &#40;i&#46;e&#46;&#44; systolic blood pressure &#60;100&#8239;mmHg&#44; respiratory rate &#62;22&#8239;rpm&#44; and Glasgow coma scale &#60;15&#41; were used&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Comorbidities were analyzed according to the Charlson comorbidity index&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Hospital-acquired infection were defined according with the Centers for Disease Control and Prevention were included&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Community-acquired infection was defined based on the physician&#8217;s classification&#44; using the International Classification of Diseases&#44; Tenth Revision &#40;ICD-10&#41;&#44; and diagnosis codes&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The primary outcome was global mortality&#46; The timing of antibiotic treatment relative to clinical diagnosis was evaluated&#46; The cultures were evaluated&#44; and appropriate antimicrobial therapy was provided to patients with sepsis&#46; The length of hospital stay was also assessed&#46; Outcomes were compared according to SIRS criteria and qSOFA scores&#44; hospital unit &#40;ICU&#44; ward&#44; or emergency room &#91;ER&#93;&#41;&#44; and positive cultures&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The continuous variables were expressed was mean or median according with normality test &#40;Kolmogorov&#8211;Smirnov test&#41;&#46; The descriptive variables were expressed as percentages&#46; The dispersion of variables were standard deviation or 95&#37; confidence interval&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the bivariate analysis&#44; <span class="elsevierStyleItalic">P</span>-values were calculated using the &#967;<span class="elsevierStyleSup">2</span> or Fisher&#8217;s exact test for categorical variables and the Student&#8217;s t-test or Mann&#8211;Whitney test for continuous variables&#46; The covariates were compared based on the criteria for sepsis and outcomes&#46; Covariates were compared between survivors <span class="elsevierStyleItalic">versus</span> non-survivors&#46; In the forward stepwise regression&#44; variables with <span class="elsevierStyleItalic">P</span>-values&#8239;&#8804;&#8239;0&#46;2 were included in the model&#44; while those with <span class="elsevierStyleItalic">P</span>-values&#8239;&#8804;&#8239;0&#46;10 were maintained in the model&#46; Multicollinearity was calculated with the variance inflation factor for each independent variable&#46; Variables which included other variables &#40;e&#46;g&#46;&#44; SIRS and qSOFA&#41; were not included in the model&#46; All tests were two-tailed&#46; A <span class="elsevierStyleItalic">P</span> significance was set at <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;05&#46; A receiver operating characteristic &#40;ROC&#41; curve was constructed based on independent variables associated with mortality and the logistic binary regression model&#46; The score was based on coefficient &#40;beta&#41; of each variable in the multivariable analysis&#46; The area under the curve &#40;AUC&#41; was calculated to determine the internal performance of the score based on multivariable analysis&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">General data</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 2&#44;232 were screened and 205 were excluded due to lack of data&#44; and 219 patients do not fulfill sepsis-3 criteria&#46; Thus&#44; 1&#44;808 were included in the study&#46; The mean age was 60 years &#40;interquartile range &#91;IQR&#93;&#58; 42&#8211;72&#41;&#44; and 38&#37; of the patients were men&#46; The SIRS criteria &#40;&#8805;2&#41; and qSOFA &#40;&#8805;2&#41; accounted for 63&#37; &#40;n&#8239;&#61;&#8239;1&#44;278&#41; and 29&#37; &#40;n&#8239;&#61;&#8239;593&#41;&#44; respectively&#46; The main sites of infection were the lungs &#40;42&#37; &#91;n&#8239;&#61;&#8239;657&#93;&#41; and abdomen &#40;15&#37; &#91;n&#8239;&#61;&#8239;236&#93;&#41;&#46; The median length of hospital stay after sepsis was 10 days &#40;IQR&#58; 4&#8211;22&#41;&#44; while death occurred in 36&#46;8&#37; of patients &#40;n&#8239;&#61;&#8239;666&#41;&#46; The mortality in patients admitted at ICU was 47&#46;7&#37;&#44; at emergency room 26&#46;2&#37;&#44; and those with diagnosis of sepsis in the ward was 26&#46;8&#37;&#46; The main comorbidities were systemic arterial hypertension &#40;SAH&#41; &#40;42&#37; &#91;n&#8239;&#61;&#8239;782&#93;&#41;&#44; diabetes mellitus &#40;DM&#41; &#40;16&#37; &#91;n&#8239;&#61;&#8239;303&#93;&#41;&#44; previous stroke &#40;14&#46;7&#37; &#91;n&#8239;&#61;&#8239;274&#93;&#41;&#44; and cancer &#40;8&#46;3&#37; &#91;n&#8239;&#61;&#8239;155&#93;&#41;&#46; Among the patients with microbiological data&#44; 45&#37; &#40;n&#8239;&#61;&#8239;626&#41; presented with positive culture results&#46; Blood cultures were obtained from all patients and other cultures&#44; according to the medical decision&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Variables associated with mortality</span><p id="par0080" class="elsevierStylePara elsevierViewall">The data from patients who died or survived are described in the <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The mortality&#44; the outcome variable&#44; was higher in ICU admitted patients &#40;p&#8239;&#60;&#8239;0&#46;001&#41;&#44; but similar between emergency room and ward&#46; Twenty variables were found to be related to death after univariate analysis&#46; Major variables were age &#40;64 <span class="elsevierStyleItalic">vs&#46;</span> 52 years&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;001&#41;&#44; length of hospital stay before sepsis &#40;10 <span class="elsevierStyleItalic">vs&#46;</span> 5&#46;4 days&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;001&#41;&#44; temperature &#62;38&#8239;&#176;C &#40;26&#37; <span class="elsevierStyleItalic">vs&#46;</span> 39&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;001&#41;&#44; leukocytes &#62;12&#44;000 or &#60;4&#44;000&#8239;cells&#47;mm<span class="elsevierStyleSup">3</span> &#40;49&#37; <span class="elsevierStyleItalic">vs&#46;</span> 38&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;001&#41;&#44; qSOFA criteria &#62;2 &#40;35&#37; <span class="elsevierStyleItalic">vs&#46;</span> 25&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;001&#41;&#44; altered level of consciousness &#40;30&#37; <span class="elsevierStyleItalic">vs&#46;</span> 21&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;001&#41;&#44; low blood pressure &#40;i&#46;e&#46;&#44; systolic blood pressure &#91;SBP&#93; &#60;90&#8239;mmHg&#41; &#40;31&#37; <span class="elsevierStyleItalic">vs&#46;</span> 21&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;001&#41;&#44; minutes to antimicrobial infusion &#40;45 min <span class="elsevierStyleItalic">vs&#46;</span> 35&#8239;min&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;001&#41;&#44; heart failure &#40;9&#46;5&#37; <span class="elsevierStyleItalic">vs&#46;</span> 4&#46;8&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;0001&#41;&#44; previous stroke &#40;20&#37; <span class="elsevierStyleItalic">vs&#46;</span> 11&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;0001&#41;&#44; SAH &#40;47&#37; <span class="elsevierStyleItalic">vs&#46;</span> 38&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;001&#41;&#44; cancer &#40;13&#37; <span class="elsevierStyleItalic">vs&#46;</span> 5&#46;5&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;001&#41;&#44; previous sepsis &#40;35&#37; <span class="elsevierStyleItalic">vs&#46;</span> 18&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;0001&#41;&#44; and positive culture &#40;50&#37; <span class="elsevierStyleItalic">vs&#46;</span> 39&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Multivariable analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">Despite these 20 variables&#44; after multivariate analysis&#44; half of them remained independent variables related to death &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Characteristics such as &#40;i&#41; cirrhosis&#44; &#40;ii&#41; dialysis&#44; and &#40;iii&#41; cancer at least doubled the risk of death&#58; &#40;i&#41; &#40;odds ratio &#91;OR&#93;&#8239;&#61;&#8239;3&#46;97&#44; 95&#37; confidence interval &#91;CI&#93; 1&#46;41&#8211;11&#46;16&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;009&#41;&#44; &#40;ii&#41; &#40;OR&#8239;&#61;&#8239;2&#46;51&#44; 95&#37; CI 1&#46;54&#8211;4&#46;10&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;0001&#41;&#44; and &#40;iii&#41; &#40;OR&#8239;&#61;&#8239;2&#46;2&#44; 95&#37; CI 1&#46;49&#8211;3&#46;24&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;0001&#41;&#46; Other variables were also related to poor prognosis increasing between 42&#8211;93&#37; the odds of death&#58; previous sepsis &#40;OR&#8239;&#61;&#8239;1&#46;42&#44; 95&#37; CI 1&#46;08&#8211;1&#46;87&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;012&#41;&#44; qSOFA criteria &#8805;2 &#40;OR&#8239;&#61;&#8239;1&#46;43&#44; 95&#37; CI 1&#46;12&#8211;1&#46;84&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;04&#41;&#44; leukocytes &#62;12&#44;000 or &#60;4&#44;000&#8239;cells&#47;mm<span class="elsevierStyleSup">3</span> &#40;OR&#8239;&#61;&#8239;1&#46;61&#44; 95&#37; CI 1&#46;27&#8211;2&#46;03&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;0001&#41;&#44; and previous stroke &#40;OR&#8239;&#61;&#8239;1&#46;88&#44; 95&#37; CI 1&#46;39&#8211;2&#46;55&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;0001&#41;&#46; A temperature &#62;38&#8239;&#176;C was related to survival &#40;OR&#8239;&#61;&#8239;0&#46;65&#44; 95&#37; CI 0&#46;51&#8211;0&#46;83&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;0001&#93;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Score definition</span><p id="par0090" class="elsevierStylePara elsevierViewall">Considering the equation of the binary regression logistic analysis&#44; the weight of each significant variable was calculated using the following equation&#58; mortality score&#8239;&#61;&#8239;2&#46;186&#8239;&#215;&#8239;&#40;chronic renal failure&#41;&#8239;&#43;&#8239;2&#46;51&#8239;&#215;&#8239;&#40;cerebrovascular disease&#41;&#8239;&#43;&#8239;2&#46;629&#8239;&#215;&#8239;&#40;cancer&#41;&#8239;&#43;&#8239;2&#46;992&#8239;&#215;&#8239;&#40;cirrhosis&#41;&#8239;&#43;&#8239;1&#46;842&#8239;&#215;&#8239;&#40;previous sepsis&#41;&#8239;&#43;&#8239;2&#46;040&#8239;&#215;&#8239;&#40;fever&#41;&#8239;&#43;&#8239;1&#46;387&#8239;&#215;&#8239;&#40;leukocytosis or leukopenia&#41;&#46; The mortality risk according to the scores is presented in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">When applying the score&#44; a ROC curve was constructed&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; considering the sensitivity and specificity of the mortality prediction score&#46; The AUC was 0&#46;668 &#40;95&#37; CI 0&#46;623&#8211;0&#46;702&#41;&#44; suggesting that the mortality score based on the multivariable analysis was weak&#46; We also performed a ROC curve for SIRS and qSOFA&#44; with AUC&#8239;&#61;&#8239;0&#46;522 &#40;95&#37; CI 0&#46;481&#8211;0&#46;563&#41; and 0&#46;583 &#40;95&#37; CI 0&#46;535&#8211;0&#46;631&#41;&#44; respectively &#40;Supplementary material&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Since the introduction of the qSOFA&#44; several publications have validated this score in different institutions and used it to assess specific infection sites&#46; The qSOFA has been used to assess patients with pyelonephritis&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> community-acquired pneumonia&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> healthcare-associated pneumonia&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and burn&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Additionally&#44; a subgroup analysis revealed that qSOFA is superior to CURB-65 in predicting the prognosis of ICU admission&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Nevertheless&#44; the last surviving sepsis campaign stated that qSOFA criteria should not be used alone for sepsis screening&#44; while medical judgment must be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Indeed&#44; according to our cohort results&#44; the positivity of the qSOFA and SIRS criteria was lower than expected &#40;29&#37; and 63&#37;&#44; respectively&#41;&#46; Therefore&#44; medical judgment started our sepsis protocol in 71&#37; and 37&#37; of patients without the qSOFA or SIRS criteria&#44; respectively&#46; Despite the use of medical judgment as a possible starting point for the overdiagnosis of sepsis&#44; the global mortality rate was 37&#37;&#46; This is in accordance with the World Health Organization&#8217;s global estimation of sepsis-treated death rates&#46; For instance&#44; 27&#37; of in-hospital mortality is related to all treated sepsis&#44; and 42&#37; of in-hospital mortality is specifically related to sepsis diagnosed in the ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> As expected&#44; differences according to world regions may exist&#44; and convergent with our results&#44; the general treated-sepsis death rates vary from 25&#8211;36&#37;&#46; Even though SIRS and qSOFA are screening tool for sepsis&#44; these scores can also be used for prediction of death in patients with diagnosis of sepsis&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In our multivariate analysis&#44; the SIRS criteria were not related to poor prognosis&#44; whereas qSOFA&#8239;&#8805;&#8239;2 was an independent variable related to death&#46; This reinforces the qSOFA criteria as a prognostic tool rather than a screening pathway&#46; Therefore&#44; the use of these criteria must be well allocated on a daily basis to decrease the causality of sepsis-related death&#44; considering a lower diagnosis if only qSOFA is used&#46; In six studies&#44; the sensitivity and specificity of qSOFA for mortality varied from 68&#37; to 90&#37; and from 27&#46;4&#37; to 79&#46;5&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> In the same studies&#44; the sensitivity of the SIRS criteria was higher &#40;93&#46;0&#8211;97&#46;4&#37;&#41;&#44; but the specificity was very low &#40;2&#8211;27&#46;5&#37;&#41;&#46; Although these scores lacked sensitivity or specificity &#40;according to the number of points&#41;&#44; combining other markers&#44; such as lactate<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a> and red blood cell distribution&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> can be a good strategy&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;32&#8211;39</span></a> However&#44; a tool that fits it will probably not become real&#44; given the difference between screening and prognosis steps&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In our cohort&#44; the absence of fever was an independent factor associated with poor prognosis&#46; This can be explained by the following two points&#58; immunosuppression at the onset of sepsis&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> and the absence of fever may falsely give a &#8220;not so bad&#8221; impression to the medical team regarding the patient&#8217;s status&#44; leading to a softened re-evaluation pathway&#46; Additionally&#44; previous studies have converged with these hypotheses and found that 30-day mortality is higher in patients with afebrile bacteremia&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Sepsis can be present without qSOFA criteria owing to the different forms of organ dysfunction and qSOFA criteria without infection&#44; such as heart failure&#46; Some studies have suggested that SIRS criteria should not be used&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> However&#44; the approach to patients is not based on specific clinical or laboratory criteria&#46; These criteria are important for didactic reasoning and diagnostic classification in clinical studies&#46; However&#44; some studies still confuse definitions with action strategies&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#44;44&#44;45</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Interestingly&#44; SIRS and qSOFA have been studied in many publications as a score risk of mortality&#44; but generally limited to specific populations&#44; such as <span class="elsevierStyleItalic">S&#46; aureus</span> infections&#44; pre-hospital care&#44; emphysematous pyelonephritis&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;46&#8211;49</span></a> Liu et al&#46; evaluated qSOFA as a risk of mortality with a AUC ROC of 0&#46;54&#44; similar with our results&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> Another large retrospective cohort showed that SOFA was better than qSOFA and SIRS&#44; with AUC ROC of 0&#46;58 and 0&#46;60 respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> These data confirm the results of our study&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Other studies evaluated in different hospitals&#44; but not in Brazilian hospitals&#44; and also without the description of analysis with implementation of bundles&#44; where intervention measures tend to be standardized and lower mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">52&#44;53</span></a> Despite this&#44; our score reached values very close to studies in the literature&#46; We even performed a ROC curve analysis for qSOFA and SIRS with our patients &#40;supplementary material&#41;&#44; but the AUC was extremely unfavorable&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Despite the inclusion of &#62;2&#44;000 patients in this study&#44; there were several limitations&#46; First&#44; this was a retrospective study&#44; which could have led to misinterpretation after the extraction of data from medical records&#46; This novel score should be validated in another cohort of patients to determine an external validation&#46; In the model&#44; patients from different settings were included&#44; and if we categorize this groups&#44; the strength of the model would decrease&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conclusion</span><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; the SIRS and qSOFA scores are not independent scores for death&#46; The the association of clinical and laboratorial data from these scores together with comorbidities resulted in a better score but not a robust predictor of death&#46; Fever was related to a better prognosis&#44; while cirrhosis&#44; dialysis&#44; prolonged length of stay&#44; and cancer had at least double the odds of death&#46; Therefore&#44; medical teams must be aware of these variables as prognosis in patients with sepsis&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Author&#39;s contribution</span><p id="par0140" class="elsevierStylePara elsevierViewall">Vinicius Nakad Orsatti &#8211; idealization&#44; draft text</p><p id="par0145" class="elsevierStylePara elsevierViewall">Victoria Stadler Tasca Ribeiro &#8211; text review</p><p id="par0150" class="elsevierStylePara elsevierViewall">Carolina de Oliveira Montenegro &#8211; data manager</p><p id="par0155" class="elsevierStylePara elsevierViewall">Clarice Juski Costa &#8211; data manager</p><p id="par0160" class="elsevierStylePara elsevierViewall">Eduardo Albanske Raboni &#8211; draft text&#44; data manager</p><p id="par0165" class="elsevierStylePara elsevierViewall">Eduardo Ramos Sampaio &#8211; draft text&#44; data manager</p><p id="par0170" class="elsevierStylePara elsevierViewall">Fernando Michielin &#8211; final review</p><p id="par0175" class="elsevierStylePara elsevierViewall">Juliano Gasparetto &#8211; idealization&#44; statistical analysis</p><p id="par0180" class="elsevierStylePara elsevierViewall">Jo&#227;o Paulo Telles &#8211; statistical analysis&#44; final text</p><p id="par0185" class="elsevierStylePara elsevierViewall">Felipe Francisco Tuon &#8211; idealization&#44; statistical analysis&#44; final text</p><p id="par0190" class="elsevierStylePara elsevierViewall">Financial disclosures&#58; None&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In this study&#44; we aimed to evaluate the death risk factors of patients included in the sepsis protocol bundle&#44; using clinical data from qSOFA&#44; SIRS&#44; and comorbidities&#44; as well as development of a mortality risk score&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">This retrospective cohort study was conducted between 2016 and 2021&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Two university hospitals in Brazil&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participants</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patients with sepsis&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Several clinical and laboratory data were collected focused on SIRS&#44; qSOFA&#44; and comorbidities&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Main variable of interest</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">In-hospital mortality was the primary outcome variable&#46; A mortality risk score was developed after logistic regression analysis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A total of 1&#44;808 patients were included with a death rate of 36&#37;&#46; Ten variables remained independent factors related to death in multivariate analysis&#58; temperature &#8805;38&#8239;&#176;C &#40;odds ratio &#91;OR&#93;&#8239;&#61;&#8239;0&#46;65&#41;&#44; previous sepsis &#40;OR&#8239;&#61;&#8239;1&#46;42&#41;&#44; qSOFA&#8239;&#8805;&#8239;2 &#40;OR&#8239;&#61;&#8239;1&#46;43&#41;&#44; leukocytes &#62;12&#44;000 or &#60;4&#44;000&#8239;cells&#47;mm<span class="elsevierStyleSup">3</span> &#40;OR&#8239;&#61;&#8239;1&#46;61&#41;&#44; encephalic vascular accident &#40;OR&#8239;&#61;&#8239;1&#46;88&#41;&#44; age &#62;60 years &#40;OR&#8239;&#61;&#8239;1&#46;93&#41;&#44; cancer &#40;OR&#8239;&#61;&#8239;2&#46;2&#41;&#44; length of hospital stay before sepsis &#62;7 days &#40;OR&#8239;&#61;&#8239;2&#46;22&#44;&#41;&#44; dialysis &#40;OR&#8239;&#61;&#8239;2&#46;51&#41;&#44; and cirrhosis &#40;OR&#8239;&#61;&#8239;3&#46;97&#41;&#46; Considering the equation of the binary regression logistic analysis&#44; the score presented an area under curve of 0&#46;668&#44; is not a potential model for death prediction&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Several risk factors are independently associated with mortality&#44; allowing the development of a prediction score based on qSOFA&#44; SIRS&#44; and comorbidities data&#44; however&#44; the performance of this score is low&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">En este estudio&#44; nuestro objetivo fue evaluar los factores de riesgo de muerte de los pacientes incluidos en el protocolo de sepsis&#44; utilizando datos cl&#237;nicos de qSOFA&#44; SIRS y comorbilidades&#44; as&#237; como el desarrollo de un puntaje de riesgo de mortalidad&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Este estudio de cohorte retrospectivo se llev&#243; a cabo entre 2016 y 2021&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Dos hospitales universitarios en Brasil&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participantes</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Pacientes con sepsis&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Se recopilaron varios datos cl&#237;nicos y de laboratorio centrados en SIRS&#44; qSOFA y comorbilidades&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variable de inter&#233;sprincipales</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">La mortalidad intrahospitalaria fue la variable de resultado primaria&#46; Se desarroll&#243; un puntaje de riesgo de mortalidad despu&#233;s del an&#225;lisis de regresi&#243;n log&#237;stica&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron un total de 1&#44;808 pacientes con una tasa de mortalidad del 36&#37;&#46; Diez variables permanecieron como factores independientes relacionados con la muerte en el an&#225;lisis multivariado&#58; temperatura &#8805;38&#8239;&#176;C &#40;odds ratio &#91;OR&#93;&#8239;&#61;&#8239;0&#46;65&#41;&#44; sepsis previa &#40;OR&#8239;&#61;&#8239;1&#46;42&#41;&#44; qSOFA&#8805;2 &#40;OR&#8239;&#61;&#8239;1&#46;43&#41;&#44; leucocitos &#62;12&#44;000 o &#60;4&#44;000 c&#233;lulas&#47;mm3 &#40;OR&#8239;&#61;&#8239;1&#46;61&#41;&#44; accidente cerebrovascular encef&#225;lico &#40;OR&#8239;&#61;&#8239;1&#46;88&#41;&#44; edad &#62;60 a&#241;os &#40;OR&#8239;&#61;&#8239;1&#46;93&#41;&#44; c&#225;ncer &#40;OR&#8239;&#61;&#8239;2&#46;2&#41;&#44; duraci&#243;n de la estancia hospitalaria antes de la sepsis &#62;7 d&#237;as &#40;OR&#8239;&#61;&#8239;2&#46;22&#41;&#44; di&#225;lisis &#40;OR&#8239;&#61;&#8239;2&#46;51&#41; y cirrosis &#40;OR&#8239;&#61;&#8239;3&#46;97&#41;&#46; Considerando la ecuaci&#243;n del an&#225;lisis de regresi&#243;n log&#237;stica binaria&#44; el puntaje present&#243; un &#225;rea bajo la curva de 0&#46;668&#44; un modelo d&#233;bil para la predicci&#243;n de la muerte&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Varios factores de riesgo se asocian de forma independiente con la mortalidad&#44; lo que permite el desarrollo de una puntuaci&#243;n de predicci&#243;n basada en datos de qSOFA&#44; SIRS y comorbilidades&#59; sin embargo&#44; el rendimiento de esta puntuaci&#243;n es bajo&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Death&#40;n&#8239;&#61;&#8239;666&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Survival&#40;n&#8239;&#61;&#8239;1142&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P-</span>value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male sex&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">276 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">410 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;017</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Length of hospital stay before sepsis&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;4 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SIRS criteria &#8805;2&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">422 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">711 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;640&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Temperature &#62;38&#46;3&#8239;&#176;C&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">177 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">454 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiac frequency &#62;90&#8239;bpm&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">352 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">592 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;685&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Respiratory frequency &#62;22&#8239;rpm&#44; &#40;n&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">314 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">455 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;09</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leukocytes &#62;12&#44;000 or &#60;4&#44;000&#8239;cell&#47;mm<span class="elsevierStyleSup">3</span>&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">309 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">442 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">qSOFA criteria &#8805;1&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">319 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">461 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">qSOFA criteria &#8805;2&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">239 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">286 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glasgow Coma Scale &#60;15&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">201 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">242 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low mean blood pressure &#40;&#60;60&#8239;mmHg&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">207 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">247 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time to antimicrobial infusion&#44; minutes&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;20&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;15&#8211;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Previous ICU admission&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Previous hospital admission&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">176 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">267 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;764&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DM&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">170 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;216&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dialysis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;006</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heart stroke&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heart failure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peripheral arterial disease&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EVA&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemiplegia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;540&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dementia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;564&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COPD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SAH&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">314 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">437 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cancer&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cirrhosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;037</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Steroids chronic use&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;142</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trauma&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">182 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">313 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elective surgery&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">203 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;365&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emergency surgery&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">227 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">343 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Previous sepsis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">203 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">210 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ward&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#42;&nbsp;\t\t\t\t\t\t\n
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                  """
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">OR&#58; odds ratio&#59; CI&#58; confidence interval&#59; qSOFA&#58; quick Sequential Organ Failure Assessment&#59; EVA&#58; encephalic vascular accident&#46; Mortality score&#8239;&#61;&#8239;2&#46;186&#8239;&#215;&#8239;&#40;Chronic renal failure&#41;&#8239;&#43;&#8239;2&#46;51&#8239;&#215;&#8239;&#40;Cerebrovascular disease&#41;&#8239;&#43;&#8239;2&#46;629&#8239;&#215;&#8239;&#40;neoplasm&#41;&#8239;&#43;&#8239;2&#46;992&#8239;&#215;&#8239;&#40;cirrhosis&#41;&#8239;&#43;&#8239;1&#46;842&#8239;&#215;&#8239;&#40;2nd sepsis&#41;&#8239;&#43;&#8239;2&#46;040&#8239;&#215;&#8239;&#40;fever&#41;&#8239;&#43;&#8239;1&#46;387&#8239;&#215;&#8239;&#40;leukocytosis&#41;&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Coefficient &#40;beta&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cancer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;49&#8211;3&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cirrhosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;992&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;507&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;676&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;41&#8211;11&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Previous sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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