the crazy-paving pattern in chest ct imaging of covid-19 patients: an alarming sign for hospitalization

Background: the outbreak of coronavirus disease 2019 (covid-19) has become a major threat to all humans. objectives: to assess the association between the patients’ clinical and laboratory records, computed tomography (ct) findings, and epidemiological features of covid-19 with the severity of the disease. patients and methods: in this retrospective case-control study conducted on the medical records of confirmed covid-19 pneumonia patients on admission, we investigated the ct manifestations and clinical and laboratory risk factors for progression to severe covid-19 pneumonia. the medical records and radiological ct features of confirmed covid-19 patients were reviewed in one public hospital and one respiratory clinic in qom, iran, from august 1 to september 30, 2020. results: of 236 confirmed covid-19 cases, 62 were infected with moderate to severe covid-19 and required hospital admission, and 174 were followed-up on an outpatient basis. a significant difference was found in the mean age of the outpatient and hospitalized groups. the incidence of bilateral lung involvement, consolidations, linear opacities, crazy-paving pattern, air bronchogram, and number of lobes involved were significantly higher in the hospitalized group compared to the outpatient group. however, the crazy-paving pattern was only significantly associated with an oxygen saturation (spo2) level < 90% and, coughing. our findings indicated that the crazy-paving pattern was significantly associated with the inflammatory phase. the presence of this pattern on admission, spo2 < 90%, older age, and diabetes were independent risk factors for progression to severe covid-19. conclusion: the crazy-paving pattern can predict the severity of covid-19, which is of great importance in the management and follow-up of covid-19 pneumonia patients. clinical factors, such as aging, male gender, and diabetes, may be risk factors for the crazy-paving pattern. severe cough is the most important clinical sign related to this pattern, along with an spo2 < 90%, which is an important sign of covid-19 severity.