Purpose As global healthcare system is overwhelmed by novel coronavirus disease MESHD (COVID-19), early identification of risks of adverse outcomes becomes the key to optimize management and improve survival. This study aimed to provide a CT-based pattern categorization to predict outcome of COVID-19 pneumonia MESHD pneumonia HP. Methods 165 patients with COVID-19 (91 men, 4-89 years) underwent chest CT were retrospectively enrolled. CT findings were categorized as Pattern0 (negative), Pattern1 ( bronchopneumonia MESHD), Pattern2 (organizing pneumonia MESHD pneumonia HP), Pattern3 (progressive organizing pneumonia MESHD pneumonia HP) and Pattern4 (diffuse alveolar damage). Clinical findings were compared across different categories. Time-dependent progression of CT patterns and correlations with clinical outcomes, i.e. discharge or adverse outcome (admission to ICU, requiring mechanical ventilation, or death MESHD), with pulmonary sequelae (complete absorption or residuals) on CT after discharge were analyzed. Results Of 94 patients with outcome, 81(86.2%) were discharged, 3(3.2%) were admitted to ICU, 4(4.3%) required mechanical ventilation, 6(6.4%) died. 31(38.3%) had complete absorption at median day 37 after symptom-onset TRANS. Significant differences between pattern-categories were found in age TRANS, disease MESHD-severity, comorbidity and laboratory results (all P<0.05). Remarkable evolution was observed in Pattern0-2 and Pattern3-4 within 3 and 2 weeks after symptom-onset TRANS, respectively; most of patterns remained thereafter. After controlling for age TRANS, CT pattern significantly correlated with adverse outcomes (Pattern4 vs. Pattern0-3 [reference]; hazard-ratio[95%CI], 18.90[1.91-186.60], P=0.012). CT pattern (Pattern3-4 vs. Pattern0-2 [reference]; 0.26[0.08-0.88], P=0.030) and C-reactive protein (>10 vs. [≤]10mg/L [reference]; 0.31[0.13-0.72], P=0.006) were risk-factors associated with pulmonary residuals. Conclusion CT pattern categorization allied with clinical characteristics within 2 weeks after symptom-onset TRANS would facilitate early prognostic stratification in COVID-19 pneumonia MESHD pneumonia HP.