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The quickSOFA (qSOFA) score is a clinical tool used to identify patients who may be at high risk for sepsis. It comprises three criteria: altered mental status, respiratory rate of 22 or greater, and systolic blood pressure of 100 mm Hg or less. Each of these criteria serves as a warning sign that the patient may be experiencing sepsis.

In this context, a heart rate of 104 beats per minute does not qualify as a warning sign according to the qSOFA criteria. While tachycardia can be a response to sepsis, it is not one of the specific components measured in the qSOFA assessment. The established thresholds for the qSOFA include a respiratory rate of 22 or more and normalized blood pressure levels that indicate potential hypoperfusion. Thus, a heart rate alone, even if elevated, does not serve as a critical warning flag within the qSOFA framework.

The other options clearly meet the established warning signs of the qSOFA criteria, with altered mental status indicating neurological impact, a respiratory rate of 28 suggesting significant respiratory distress, and a systolic blood pressure of 86 showing potential for shock due to inadequate circulation.