Background: Pleural effusion, the abnormal accumulation of fluid within the pleural space, is a difficult and common clinical problem faced by general practitioners and pulmonologists. Patients with pleural effusion have higher morbidity and mortality than those without pleural effusion. Little is known about treatment outcomes and associated factors in hospitalized patients with pleural effusion in Ethiopia. Objective: To determine the treatment outcome of pleural effusion and related factors in hospitalized patients with pleural effusion at Tibebe ghion Specialized Hospital, Bahir Dar, North-West Ethiopia. Methods: A facility based retrospective cross-sectional study were conducted among patients who were admitted to medical ward with pleural effusion in Tibebe ghion specialized Hospital from August 1st, 2019 to September 1,2022. Descriptive and analytical statistics were employed. Simple and multiple binary logistic regression analysis were used to examine association between dependent and independent variables. Significant variables on bivariate logistic regression analyses (P≤0.25) were included in multivariate logistic regression analyses to identify independent predictors of treatment outcomes. significance of statistical association was tested using 95% confidence interval and P value less than 0.05. Results: A total of 240 patients with hospitalized patients with pleural effusion were analyzed. 132 were males. Male: female ratio was 1.2: 1, Cough was the most common presenting symptom in 229 of these patients (95.4%), followed by SOB (172.9%) and fever (134.8%). On physical examination, decreased or absent air entry 160 (71.7%) Dullness to percussion 108(48.4%), body swelling was traced in 76 (34.1%). The most common cause of pleural effusion was tuberculosis in 67 patients (27.9%), followed by cancer 62 (25.8%), CHF 41 (17.0 %) and Parapneumonic effusion 27(11.3%). Of the total study participants, treatment outcomes at discharge Good in 176 (73.3%) of a nd 27 .7 % h a d po or out c om e . ( 52 (21.7 %) worsened without death, and 12 (5.0%) died during hospitalization). malignant pleural effusions (AOR 2.43, 95% CI (1.10-5.38), and massive pleural effusion (AOR 2.16,95 % CI (1.17–3.992) were predictors of treatment outcomes. Conclusion: The majority of study participants experienced good treatment outcomes. Massive and malignant effusions were significantly associated with treatment outcomes. Optimal management requires a multidisciplinary approach, and optimal outcome in patients with pleural effusion requires identification of etiology and early intervention.