Backgrounds Validated tools for predicting individual in-hospital mortality of COVID-19 are lacking. We aimed to develop and to validate a simple clinical prediction rule for early identification of in-hospital mortality of patients with COVID-19. Methods and findings We enrolled 2191 consecutive hospitalized patients with COVID-19 from three Italian dedicated units (derivation cohort: 1810 consecutive patients from Bergamo and Pavia units; validation cohort: 381 consecutive patients from Rome unit). The outcome was in-hospital mortality. Fine and Gray competing risks multivariate model (with discharge as a competing event) was used to develop a prediction rule for in-hospital mortality. Discrimination and calibration were assessed by the area under the receiver operating characteristic curve (AUC) and by Brier score in both the derivation and validation cohorts. Seven variables were independent risk factors for in-hospital mortality: age (Hazard Ratio [HR] 1.08, 95% Confidence Interval [CI] 1.07–1.09), male sex (HR 1.62, 95%CI 1.30–2.00), duration of symptoms before hospital admission <10 days (HR 1.72, 95%CI 1.39–2.12), diabetes (HR 1.21, 95%CI 1.02–1.45), coronary heart disease (HR 1.40 95% CI 1.09–1.80), chronic liver disease (HR 1.78, 95%CI 1.16–2.72), and lactate dehydrogenase levels at admission (HR 1.0003, 95%CI 1.0002–1.0005). The AUC was 0.822 (95%CI 0.722–0.922) in the derivation cohort and 0.820 (95%CI 0.724–0.920) in the validation cohort with good calibration. The prediction rule is freely available as a web-app (COVID-CALC: https://sites.google.com/community.unipa.it/covid-19riskpredictions/c19-rp). Conclusions A validated simple clinical prediction rule can promptly and accurately assess the risk for in-hospital mortality, improving triage and the management of patients with COVID-19.

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Human migration involves the movement of people from one place to another. An example of undirected migration is Italian student mobility where students move from the South to the Center-North. This kind of mobility has become of general interest, and this work explores student mobility from Sicily towards universities outside the island. The data used in this paper regards six cohorts of students, from 2008/09 to 2013/14. In particular, our goal is to study the 3-step migration path: the area of origin (Sicilian provinces), the regional university for the bachelor's degree, and the regional university for the master's. Our analysis is conducted by building a multipartite network with four sets of nodes: students; Sicilian provinces; bachelor region of studies; and the master region of studies. By projecting the students' set onto the others, we obtain a tripartite network where the number of students represents the link weight. Results show that the big Sicilian cities-Palermo, Catania, and Messina-have different preferential paths compared to small Sicilian cities. Furthermore, the results reveal preferential paths of 3-step mobility that only, in part, reflect a south-north orientation in the transition from the region of study for the bachelor degree to that for the master's.

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