Objective: The aim of the study was to find out the impact of different clinical and biochemical features on the final outcome in a child with SAM. Materials and methods: Study was conducted in Department of Pediatrics, King George Medical University, Lucknow, a tertiary care teaching hospital in Northern India. It was a prospective observational study done over one year. Patients with World Health Organization (WHO) defined SAM from 6 months to 5 years were included in the study. A data collection form was designed and all the details were recorded in it. Standard statistical methods of analysis were used. Results: A total of 65 patients were enrolled during the study period of 1 year, out of which 69.2% of patients were discharged, 15.4% expired whereas in 15.4% the final outcome was not recorded as the patients went LAMA or absconded. The hospital stay of patients ranged from 6–21 days with mean and SD (10.22±4.20) days and median 10 days. We found direct association of final outcome with hypothermia (OR = 4.67, CI (1.05–20.67), p=0.042). Whereas skin manifestation (OR = 4.00, CI (0.95–16.87), p=0.059) increases the risk of bad outcome but not significantly. Apart from this the CNS status of the patient has a significant effect (OR=4.67, CI (1.05–20.67), p=0.042) on the outcome. We also found significant and direct association of poor final outcome with hypoglycemia (OR = 5.25, CI (1.24–22.32), p=0.025) and HIV reactivity (OR = 14.37, CI (1.54–380.38), p=0.032). However, it did not (p>0.05) correlate well with other parameters. Conclusion: Sensorium (GCS ≤ 8) of the patients is the only independent predictor of mortality in patients with severe acute malnutrition.