The aim of this study is to see the role of the chest X-ray severity index (Brixia score) as a predictor of requiring invasive positive pressure ventilation in COVID-19-positive patients. This descriptive cross-sectional prospective study were carried out in the Department of Pulmonology and Radiology, Mayo Hospital, Lahore. The data were collected from 1st May to 30th July 2020 from 60 consecutive COVID-19 positive patients. Analysis was conducted using each patient's age, gender, clinical presentation, and the report of CXR containing the most elevated score. The mean age of the study participants was 59.43±11.27, and 81.7% of patients had positive Brixia scores (≥8). Brixia score had high sensitivity (93.886) and specificity (90.91%) to predict the need for IPPV using chest X-rays. It showed excellent predictive power, having a high numerical AUC (0.870) and a statistically significant p-value (<0.0001). High Brixia score conferred a high risk of the need for invasive positive pressure ventilation due to COVID-19. Key Words: Chest X-ray, Brixia score, COVID-19, Invasive positive pressure ventilation.