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.