Objective To evaluate the risk factors affecting outcomes of the patients with severe Coronavirus disease 2019 (COVID-19). Methods Patients with confirmed COVID-19 from January 17, 2020 to February 26, 2020 were recruited. A total of 359 participants including 195 males and 164 females were analyzed. The severe COVID-19 patients were classified into survival group and death group.There were 51 subjects in survival group and 15 subjects in death group. Categorical variables were compared using the chi-squared test or Fisher’s exact probability test among three groups. Continuous variables were compared using one-way ANOVA when the data were normally distributed for multiple-group; otherwise, the Kruskal-Wallis H test was used. The differences in general data and laboratory indicators were tested. Cox regression analysis was conducted to obtain the independent risk factors from the laboratory indicators. Results Hypertension, COPD, malignant tumor, liver injury and ARDS showed significant difference between two groups. The level of leucocytes, neutrophils, PT, APTT and AST at peak time, CRP and PCT (P＜0.05) were higher in death group compared to survival group. Meanwhile, compared with the survival group, level of lymphocyte and hemoglobin on admission, the valley value of platelets and lymphocyte ( P ＜0.05) were lower in death group. ARDS (HR=6.316, 95% CI:1.342-29.713), peak PT (HR:1.200, 95%CI:1.067-1.349), and CRP (HR=1.026, 95% CI:1.012-1.040) were independent risk factors and increased lymphocyte on admission (HR=0.014, 95% CI:0.001-0.322) was protective factor for prognosis of the death of severe COVID-19 patients. Conclusions We should pay close attention to the ARDS, the level of CRP, PT and lymphocyte for severe patients. It will help us to identify the patients with high risk of death in the early stage, and take effective treatment measures as early as possible to improve the prognosis.