Background: Malnutrition is still a global problem contributing to mortality and morbidity of many children in the world. Despite, different strategies and interventions are implementing to reduce child mortality in Ethiopia; the rate of mortality is still high. Therefore, estimated time to death and its predictors will provide input for program planners and decision-makers for under-five child care. Objective: The aim of this study was to assess survival status and predictors of mortality among severe acute malnourished children admitted at Felege-Hiwot Comprehensive Specialized Hospital from 2016-2019, Northwest Ethiopia, 2020. Methods: An institutional-based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019.The study participants were selected by simple random sampling technique. Data were entered using Epi-Data Version 3.1 and analyzed using STATAVersion15 statistical software. The Kaplan Meir was used to estimate median survival time and the cumulative probability of survival and log-rank tests was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify significant predictors. Results: Out of the total of 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of54(11.34%) children died with an incidence rate of 9.1death /1000 person- days and overall mean survival time were36 days. Failed appetite test (AHR: 2.4(CI: 1.26, 4.67), impaired consciousness level at admission (AHR: 2.4(CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3 (CI: 1.40, 7.87), edema (AHR 2.9(CI: 1.45, 5.66) and HIV/AIDS infected children (AHR: 2.8(CI: 1.24, 6.36) were independent predictors of mortality. Conclusion: The overall survival status of severe acute malnourished children was low as compared to national standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, not intake of F-100, HIV/AIDS, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of patients with identified predictors will improve child survival. Keywords: Mortality, Severe Acute Malnutrition, Survival status, Time to death.