Background: Lung ultrasound (LUS) imaging is a quick, non-invasive, accurate and quantitative method. Its prognostic value in those with Coronavirus disease 2019 (COVID-19) is still unknown. Aim: To know if poor outcomes in COVID-19 patients could be predicted on the basis of LUS score at admission. Patients and methods: A prospective cohort study involved 40 patients diagnosed with COVID-19 according to Egyptian protocol for management of COVID-19 patients. All patients subjected to full history taking, clinical assessment, laboratory investigation (routine labs, serum ferritin, C-reactive  protein, LDH and D-dimer) and imaging (chest X-ray, ultrasound and CT without contrast). Results: The baseline LUS score of patients was significantly higher among patients who needed mechanical ventilation and patients who died at admission (p=0.012 and 0.015 at admission, respectively) and at 4th day (0.026 and 0.024 at 4th day, respectively). Baseline LUS score could predict the need of MV at cutoff value >17 with sensitivity 73.68%, specificity 66.67%, PPV 66.7% and NPV 73.7% and could predict the mortality at cut off value 17 with sensitivity 70%, specificity 65%, PPV 66.7%, NPV 68.4%. Conclusion: Lung ultrasound score was a strong predictor of mortality, ICU admission, and the need for mechanical ventilation in patients with critical condition.