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In this context&#44; it seems essential to have validated tools that can determine&#44; as quickly as possible&#44; which SARS-CoV-2-infected patients are at a higher risk of developing respiratory failure and&#47;or dying&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The Sepsis-3 task force recommends the quick Sequential &#40;Sepsis-Related&#41; Organ Failure Assessment &#40;qSOFA&#41; score for identifying patients with suspected infection who are at greater risk of poor outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Subsequent publications found that general early warning scores&#44; such as the National Early Warning Score &#40;NEWS&#41;&#44; were more accurate than the qSOFA score for predicting clinical deterioration&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Some authors propose using a simplified modification of NEWS called quick NEWS &#40;qNEWS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These scores&#8217; accuracy in predicting a poor clinical outcome have not previously been reported in patients with COVID-19&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study aimed to evaluate the use of two sepsis-focused criteria&#44; SOFA and qSOFA&#44; and two general early warning scores&#44; qNEWS&#44; and NEWS&#44; calculated at admission for predicting respiratory failure and death among patients with confirmed COVID-19&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Study population and design</span><p id="par0025" class="elsevierStylePara elsevierViewall">This work is a retrospective observational study including all hospitalized adult patients with COVID-19 on March 16&#44; 2020&#46; This day marked the beginning of the worst wave of the epidemic in our region to date&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patient follow-up continued until April 16&#44; 2020 or death&#46; COVID-19 was diagnosed <span class="elsevierStyleItalic">via</span> a SARS-CoV-2 real-time reverse transcription polymerase chain reaction &#40;RT-PCR&#41; of a nasopharyngeal swab or sputum samples&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical characteristics&#44; radiological features&#44; laboratory values&#44; and vital signs at admission were gathered from electronic medical records&#46; For the validation of each case&#44; all the vital signs and laboratory data necessary to calculate qSOFA&#44; SOFA&#44; NEWS&#44; and qNEWS were determined &#40;see Supplementary Table 1&#41;&#46; The first available data from each patient were used to calculate the scores&#46; qNEWS values were calculated using only the blood pressure&#44; respiratory rate&#44; and level of consciousness components of NEWS with the same weightings for each cutoff as in NEWS&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The protocol was approved by the 12 de Octubre Hospital Review Board &#40;reference 20&#47;117&#41; and a waiver of informed consent was granted due to the study&#39;s retrospective observational design&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Definition of endpoints</span><p id="par0045" class="elsevierStylePara elsevierViewall">Respiratory failure was defined as a PaO2&#47;FiO2 ratio &#8804;200<span class="elsevierStyleHsp" style=""></span>mmHg<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> or the need for mechanical ventilation &#40;either non-invasive positive pressure ventilation &#40;including high-flow nasal cannula oxygen&#41; or invasive mechanical ventilation&#41;&#46; Respiratory failure could occur at any time during hospital admission&#46; As Supplementary Table 2 shows&#44; the median time from admission to respiratory failure was 3 days &#40;interquartile ranges&#58; 1&#8211;5&#46;7&#41;&#46; In-hospital mortality during the 30-day follow-up was recorded&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Statistical methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">Descriptive analysis was performed using means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or medians with interquartile ranges &#40;IQR&#41;&#46; The Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used to compare continuous variables with a non-normal distribution and Fisher&#39;s exact test to compare proportions&#46; Predictive accuracy was estimated using sensitivities&#44; specificities&#44; negative and positive predictive values&#44; and negative and positive likelihood ratios&#46; Receiver operating characteristic &#40;ROC&#41; curve analysis was performed to determine the best SOFA&#44; qSOFA&#44; NEWS&#44; and qNEWS cut-off value associated with the presence of respiratory failure or in-hospital death by means of Youden&#39;s index&#46; Statistical analysis was performed with using SPSS Statistics for Windows&#44; Version 19&#46;0 &#40;IBM&#44; Armonk&#44; NY&#58; IBM Corp&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 237 patients were included&#46; Patients&#8217; main demographic and clinical characteristics are shown in Supplementary Table 2&#46; The median time from the onset of symptoms to the first positive RT-PCR was 5 days &#40;interquartile range&#58; 3&#8211;7&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">During hospitalization&#44; 70&#37; of patients needed oxygen therapy while respiratory failure was observed in 32&#37; of cases&#46; ICU admission and overall in-hospital mortality occurred in 12&#46;2&#37; and 20&#46;7&#37; of patients&#44; respectively&#46; Mortality was higher in the respiratory failure group &#40;47&#47;77 &#40;61&#37;&#41; <span class="elsevierStyleItalic">vs&#46;</span> 2&#47;160 &#40;1&#46;3&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; ICU mortality was 41&#46;4&#37; &#40;12&#47;29&#41; <span class="elsevierStyleItalic">vs&#46;</span> 17&#46;8&#37; &#40;37&#47;208&#41; in non-ICU patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The most common SOFA&#44; qSOFA&#44; NEWS&#44; and qNEWS values at admission were 0 &#40;35&#37;&#41;&#44; 0 &#40;69&#37;&#41;&#44; 2 &#40;15&#46;6&#37;&#41;&#44; and 0 &#40;57&#46;8&#37;&#41;&#46; Measures of the diagnostic accuracy of SOFA&#44; qSOFA&#44; NEWS&#44; and qNEWS for the presence of respiratory failure or in-hospital death are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The best cut-off values for predicting respiratory failure and mortality for qSOFA&#44; SOFA&#44; NEWS&#44; and qNEWS were &#8805;1&#44; &#8805;2&#44; &#8805;4&#44; and &#8805;2&#44; respectively&#46; These cut-off points were observed in 30&#46;4&#37;&#44; 45&#46;5&#37;&#44; 42&#46;2&#37;&#44; and 22&#46;4&#37; of the study cohort&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">NEWS &#40;AUC&#58; 0&#46;75&#44; 95&#37; CI&#58; 0&#46;69&#8211;0&#46;8&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; was the most accurate score for predicting respiratory failure at admission &#40;see Supplementary Fig&#46; 1&#41; and the difference with qSOFA approached statistical significance &#40;qSOFA AUC&#58; 0&#46;69&#44; 95&#37; IC&#58; 0&#46;62&#8211;0&#46;74&#44; pairwise comparison&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;09&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding mortality&#44; SOFA &#40;AUC&#58; 0&#46;77&#59; 95&#37; IC&#58; 0&#46;72&#8211;0&#46;83&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; was slightly more accurate than the other scores &#40;see Supplemenatary Fig&#46; 2 and Table 3&#41;&#46; The specificity and sensitivity of different score cut-offs with 95&#37; confidence intervals are listed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In a situation like the COVID-19 pandemic&#44; it is vital to predict and identify how many patients are at risk of developing respiratory failure and&#47;or death as soon as possible in order to ensure the appropriate availability of hospital facilities and ventilatory support equipment&#46; Therefore&#44; the use of simple tools such as sepsis scores&#44; which are mainly based on clinical signs&#44; would be of great value for improving the clinical management of this population&#46; However&#44; to date&#44; these scores have not been evaluated in COVID-19 patients&#46; Moreover&#44; these scores have been validated to predict death and ICU transfer&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> but not respiratory failure&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In our experience&#44; up to 30&#37; of hospitalized COVID-19 patients developed respiratory failure&#44; 12&#37; were admitted to the ICU&#44; and 20&#37; died&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The NEWS score seems to be the most suitable tool for predicting respiratory failure as it has the best AUC&#44; better sensitivity and specificity compared to qSOFA&#44; and similar values when compared to the more complex SOFA score&#46; For both outcomes&#44; SOFA has the highest sensitivity whereas qSOFA has the best specificity&#46; Overall&#44; our results on COVID-19 patients are similar to what other authors have reported in non-COVID-19 patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A striking aspect is that in COVID-19&#44; the NEWS cut-off was &#8805;4&#44; lower than the scores of 5 or 7 which are normally used in sepsis&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;10</span></a> This lower cut-off value could be explained by the fact that patients with COVID-19 do not usually present with hypotension&#8212;in our study&#44; systolic blood pressure &#8804;110<span class="elsevierStyleHsp" style=""></span>mmHg was present in just 15&#37; of patients&#8212;and only 7&#37; had alteration of level of consciousness&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">On the other hand&#44; it should be noted that each score has a high negative predictive value for respiratory failure and mortality&#44; ranging from 79&#8211;84&#37; to 88&#8211;93&#37;&#44; respectively&#46; Therefore&#44; the inclusion of these scores in the early clinical evaluation of patients with COVID-19 might be useful for accurately excluding the development of serious complications&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Overall&#44; our analysis shows that the use of these scores allows for early identification of patients at higher risk&#46; This has direct clinical implications in a pandemic as devastating as COVID-19&#44; making it easier to plan the allocation of scarce and complex resources like ICU beds and respiratory support equipment&#46; This is especially advantageous because the median time from admission to the emergency department to ICU transfer was 1 day &#40;IQR&#58; 1&#8211;5&#41;&#44; which implies that patients may require ICU admission in the first hours of their care&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">An important strength of our study is that patient follow-up lasted for one month or until death&#46; This increases the reliability of our data&#44; since severe COVID-19 patients may have long hospital stays&#46; In fact&#44; the median hospital stays among survivors with respiratory failure and ICU admission were 21 days &#40;IQR 16&#8211;28&#41; and 28 days &#40;IQR 22&#8211;33&#41;&#44; respectively&#46; Median time to in-hospital death was 9 days &#40;IQR 7&#8211;12&#41; &#40;see Supplementary Table 2&#41;&#46; These long hospital stays in patients with severe COVID-19 disease must be taken into account in order to wisely manage hospital resources&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Our analysis has the limitations inherent to retrospective studies&#46; However&#44; vital signs and analytical values were obtained in all cases&#46; Furthermore&#44; this work reports the experience of a single center in the particular context of the first wave of the pandemic&#46; Therefore&#44; our data must be validated by others&#44; especially regarding respiratory failure&#44; given that these scores have previously been used for predicting mortality&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall">In conclusion&#44; the predictive accuracies of sepsis scores in relation to respiratory failure and in-hospital mortality in COVID-19 were similarly useful to those previously reported in sepsis&#46; Overall&#44; we found that early assessment of NEWS is the best tool for predicting respiratory failure in COVID-19 patients and may allow physicians and hospital managers to ensure appropriate management of non-ICU SARS-CoV-2 infected individuals&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Ethical approval</span><p id="par0125" class="elsevierStylePara elsevierViewall">The study protocol was approved by the 12 de Octubre University Hospital Review Board &#40;number reference 20&#47;117&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">Mikel Manche&#241;o-Losa was supported by a &#8220;R&#237;o Hortega&#8221; Research Contract from the Instituto de Salud Carlos III &#40;CM19&#47;00226&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Author contributions</span><p id="par0135" class="elsevierStylePara elsevierViewall">A&#46; Lalueza&#44; J&#46; Lora-Tamayo&#44; C&#46; de la Calle&#44; and C&#46; Lumbreras designed the study&#46; G&#46; Maestro&#44; J&#46; Sayas&#44; R&#46; Garc&#237;a&#44; and A&#46; Lalueza screened the patients&#46; A&#46; Lalueza&#44; J&#46; Lora-Tamayo&#44; C&#46; de la Calle&#44; G&#46; Maestro&#44; J&#46; Sayas&#44; E&#46; Arrieta&#44; M&#46; Manche&#241;o&#44; &#193;&#46; March&#225;n&#44; R&#46; D&#237;az-Sim&#243;n&#44; A&#46; Garc&#237;a-Reyne&#44; and B&#46; de Miguel did data acquisition&#46; A&#46; Lalueza performed the statistical analysis&#46; A&#46; Lalueza and C&#46; Lumbreras created the first draft of the article&#46; A&#46; Lalueza&#44; G&#46; Maestro&#44; M&#46; Catal&#225;n&#44; R&#46; Garc&#237;a&#44; and C&#46; Lumbreras participated in the data interpretation and edited the article&#46; A&#46; Lalueza and C&#46; Lumbreras wrote the final draft of the article and made all the changes suggested by the coauthors&#46;</p></span></span>"
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            1 => "SARS-CoV-2"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This observational retrospective study aimed to investigate the usefulness of Sequential Organ Failure Assessment &#40;SOFA&#41;&#44; Quick SOFA &#40;qSOFA&#41;&#44; National Early Warning Score &#40;NEWS&#41;&#44; and quick NEWS in predicting respiratory failure and death among patients with COVID-19 hospitalized outside of intensive care units &#40;ICU&#41;&#46; We included 237 adults hospitalized with COVID-19 who were followed-up on for one month or until death&#46; Respiratory failure was defined as a PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio &#8804;200<span class="elsevierStyleHsp" style=""></span>mmHg or the need for mechanical ventilation&#46; Respiratory failure occurred in 77 patients &#40;32&#46;5&#37;&#41;&#44; 29 patients &#40;12&#37;&#41; were admitted to the ICU&#44; and 49 patients &#40;20&#46;7&#37;&#41; died&#46; Discrimination of respiratory failure was slightly higher in NEWS&#44; followed by SOFA&#46; Regarding mortality&#44; SOFA was more accurate than the other scores&#46; In conclusion&#44; sepsis scores are useful for predicting respiratory failure and mortality in COVID-19 patients&#46; A NEWS score &#8805;4 was found to be the best cutoff point for predicting respiratory failure&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El presente estudio retrospectivo observacional tiene como objetivo analizar la utilidad de las escalas SOFA &#40;<span class="elsevierStyleItalic">Sequential Organ Failure Assessment</span>&#41;&#44; qSOFA &#40;<span class="elsevierStyleItalic">Quick SOFA</span>&#41;&#44; NEWS &#40;<span class="elsevierStyleItalic">National Early Warning Score&#41;</span> y <span class="elsevierStyleItalic">Quick NEWS</span> para predecir el fallo respiratorio y la muerte en pacientes con COVID-19 atendidos fuera de la Unidad de Cuidados Intensivos &#40;UCI&#41;&#46; Se incluyeron 237 adultos con COVID-19 hospitalizados seguidos durante un mes o hasta su fallecimiento&#46; El fallo respiratorio se defini&#243; como un cociente PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#8804; 200<span class="elsevierStyleHsp" style=""></span>mmHg o la necesidad de ventilaci&#243;n mec&#225;nica&#46; Setenta y siete pacientes &#40;32&#44;5&#37;&#41; desarrollaron fallo ventilatorio&#59; 29 &#40;12&#37;&#41; precisaron ingreso en UCI&#44; y 49 fallecieron &#40;20&#44;7&#37;&#41;&#46; La discriminaci&#243;n del fallo ventilatorio fue algo mayor con la puntuaci&#243;n NEWS&#44; seguida de la SOFA&#46; En cuanto a la mortalidad&#44; la puntuaci&#243;n SOFA fue m&#225;s exacta que las otras escalas&#46; En conclusi&#243;n&#44; las escalas de sepsis son &#250;tiles para predecir el fallo respiratorio y la muerte en COVID-19&#46; Una puntuaci&#243;n &#8805; 4 en la escala NEWS ser&#237;a el mejor punto de corte para predecir fallo respiratorio&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Lalueza A&#44; Lora-Tamayo J&#44; de la Calle C&#44; Sayas-Catal&#225;n J&#44; Arrieta E&#44; Maestro G&#44; et al&#46; Utilidad de las escalas de sepsis para predecir el fallo respiratorio y la muerte en pacientes con COVID-19 fuera de las Unidades de Cuidados Intensivos&#46; Rev Cl&#237;n Esp&#46; 2022&#59;222&#58;293&#8211;298&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">The COVID&#43;12 Group is a member of the SEMI-COVID-19 Network&#44; an initiative of the Spanish Society of Internal Medicine &#40;SEMI&#44; as its initials in Spanish&#41;&#46;</p>"
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                  \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">AUC&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">Youden&#39;s Index&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">Cut-off&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">Sensitivity &#40;&#37;&#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">Specifity &#40;&#37;&#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">PPV &#40;&#37;&#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">NVP &#40;&#37;&#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">&#43;LR&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">&#8722;LR&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 " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Respiratory failure</span></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"><span class="elsevierStyleHsp" style=""></span>qSOFA&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69 &#40;0&#46;62&#8211;0&#46;74&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;37&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;1&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;84 &#40;44&#46;1&#8211;67&#46;2&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;87 &#40;75&#46;0&#8211;87&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;72 &#40;47&#46;5&#8211;70&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;39 &#40;72&#46;2&#8211;85&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;08 &#40;2&#46;1&#8211;4&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;54 &#40;0&#46;4&#8211;0&#46;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>SOFA&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;732 &#40;0&#46;67&#8211;0&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;2&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;68 &#40;62&#46;3&#8211;83&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;37 &#40;61&#46;6&#8211;76&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;33 &#40;43&#46;4&#8211;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;73 &#40;77&#46;1&#8211;90&#46;2&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;41 &#40;1&#46;84&#8211;3&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;38 &#40;0&#46;26&#8211;0&#46;56&#41;&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"><span class="elsevierStyleHsp" style=""></span>NEWS&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;751 &#40;0&#46;69&#8211;0&#46;80&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;4&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;43 &#40;60&#46;0&#8211;81&#46;2&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;87 &#40;64&#46;2&#8211;78&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;44&#46;7&#8211;64&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;9 &#40;76&#46;4&#8211;89&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;54 &#40;1&#46;91&#8211;3&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4 &#40;0&#46;28&#8211;0&#46;57&#41;&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"><span class="elsevierStyleHsp" style=""></span>qNEWS&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;695 &#40;0&#46;63&#8211;0&#46;75&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;35&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;2&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;04 &#40;49&#46;2&#8211;72&#46;0&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;38 &#40;66&#46;8&#8211;80&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;4 &#40;42&#46;5&#8211;64&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;87 &#40;72&#46;3&#8211;85&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;38 &#40;1&#46;73&#8211;3&#46;28&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;52 &#40;0&#46;4&#8211;0&#46;7&#41;&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 " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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 " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In-hospital mortality</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></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"><span class="elsevierStyleHsp" style=""></span>qSOFA&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;716 &#40;0&#46;65&#8211;0&#46;77&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;1&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;27 &#40;48&#46;3&#8211;76&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;19 &#40;71&#46;6&#8211;83&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;31&#46;6&#8211;55&#46;2&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;1 &#40;83&#8211;93&#46;2&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9 &#40;2&#46;06&#8211;4&#46;09&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47 &#40;0&#46;32&#8211;0&#46;68&#41;&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"><span class="elsevierStyleHsp" style=""></span>SOFA&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;778 &#40;0&#46;72&#8211;0&#46;83&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;48&nbsp;\t\t\t\t\t\t\n
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