Background: The severe COVID-19 diseases vary among patients. This can be due to the virus strain, the host genetic makeup, the host health condition, or the immunity status of the patient. As a result, different viruses and genetic variants or comorbidities may all play a role in the variation in severe COVID-19 among patients. WHO reports that the mortality and morbidity of COVID-19 disease still continue but never concluded the risk factors of severe COVID-19 because SARS-cov-2 is a completely new virus. Objective: To identify risk factors of severe COVID-19 among confirmed cases in Tibebe Ghion Specialized Hospital, Bahir Dar City, Northwest Ethiopia in 2022. Methods: Facility-based unmatched case-control study was conducted from January 15 to May 30, 2022. A total of 242 (81 cases consecutively and 161 controls randomly) selected participants were included in the study. Data were collected using structured questionnaires. Epi Info version 7 was used to enter the collected data, and then exported to SPSS version 25 for analysis. In the descriptive analysis frequencies, proportions and percentages of study variables were computed. At bivariate analysis variables with a p-value of <0.25 were selected as candidate variable for multiple variable logistic regression. Multivariable logistic regression was used to identify statistically significant independently associated variables with severe COVID-19 using adjusted odds ratio [AOR] with 95% CI and p-value <0.05. Results: Among the total 242 COVID-19 study participants 153 (63.2%), were males 88 (36.4%) civil servants and 96 (39.7%) were secondary level in educational status. Age group 40-59 years [AOR]:2.581; CI:1.358-4.905;), headache (AOR: 2.581; CI:1.358-4.905;), difficulty of breathing (AOR: 2.235; CI:1.036-4.822;), persistent fever (AOR: 1.925; CI:1.009-3.673;), hypertension (AOR:2.564; CI:1.046–6.285;), and diabetes mellitus (AOR, 2.906; CI, 1.317–6.413;) were significantly associated with severe COVID-19. However, there was no significant association between ABO blood type and severe COVID-19 disease. Conclusion: In this study, study participants in the age group between 40 and 59, with clinical symptoms of headache, difficulty of breathing, persistent fever and chronic conditions of hypertension and diabetes mellitus were identified as statistically significantly associated with severe COVID-19 disease. Therefore, healthcare providers need to assess and give prompt management to patients with risk factors for severe COVID-19 diseases. Key words: Severe COVID-19, Factors, Bahir Dar, Ethiopia