Objective: This study aimed to investigate the clinical and computed tomography (CT) features associated with severe and critical coronavirus disease-2019 (COVID-19) pneumonia.

Methods: A total of 50 patients with critical COVID-19 pneumonia, receiving mechanical ventilation support in the intensive care unit (ICU) due to moderate-severe acute respiratory distress syndrome (ARDS), were included in this retrospective study. Chest CT, laboratory results, and clinical conditions of patients were concurrently identified. Only the first chest CT findings of patients were reviewed by 50 physicians
and they were asked about their opinions on the laboratory results and clinical conditions of patients. Data were then compared with the real-time data. The efficacy of the first chest CT findings in diagnosis and treatment guidance was analyzed.

Results: The simultaneous laboratory analyses of patients receiving mechanical ventilation support due to moderate-severe ARDS found a C-reactive protein of >40 mg/L in 72%, D-dimer was >1000 ng/mL and ferritin was >500 ng/mL in 57%, and lymphocyte count <800 μL in 50% of patients. While 53% of participants proposed that patients would be treated in the ICU, 28.2% suggested the patients be treated in inpatient care. A total of 60.2% of participants stated that the patients suffered from moderate-severe ARDS based on CT findings.

Conclusion: A correlation was found between the clinical symptoms, laboratory analyses, and CT findings of patients presenting with severe COVID-19. The first chest CT alone may help a physician to determine the disease severity; however, additional laboratory data and clinical follow-up are needed to evaluate the prognosis and plan the treatment, as many factors are involved in determining the disease severity.