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INTRODUCTION: The recent corona virus disease (COVID-19) pandemic overwhelmed the medical system. Preexisting comorbidities such as diabetes mellitus and hypertension greatly influenced the course and outcome of this viral illness, especially in the elderly population. Laboratory parameters such as neutrophil to lymphocyte ratio (N/L), serum ferritin, serum D-dimer, and serum lactate dehydrogenase (LDH) have also been correlated with the severity of the disease in these patients. The present study aims to assess the determinants of severity of COVID-19 disease in an attempt to improve the prognostication and management of health care resources during a pandemic. MATERIAL AND METHODS: 544 confirmed adult patients infected with COVID-19, who were admitted in Bharati Hospital and Medical College, Pune, Maharashtra, India, were included in this retrospective, observational study from February 2021 to June 2021. All patients were classified into mild, moderate and severe group according to the severity of the disease. Demographic, epidemiological, and radiological characteristics of the patients were studied and possible determinants of the severity of the disease among them were assessed. RESULTS: This study found that the mean age in group 3 (severe illness) was significantly higher than the other groups. Significantly, patients in group 3 were found to have preexisting diabetes mellitus and hypertension more than the other groups. The average values of the neutrophil-to-lymphocyte ratio, white blood cell count, C-reactive protein, serum ferritin, LDH, random blood glucose level, and glycosylated hemoglobin (HbA1c) were significantly correlated with the severity of COVID-19 illness. Patients who had consolidation findings on chest radiography and high computed tomography severity score (CT-SS) were significantly associated with severe COVID-19 disease. CONCLUSIONS: In this study, it has been observed that older age; comorbidities such as hypertension, diabetes mellitus; neutrophil-to-lymphocyte ratio, reactive protein, serum ferritin, lactate dehydrogenase and glycosylated hemoglobin (HbA1c) are significantly associated with the severity of COVID-19 infection. Knowledge of these determinants of severity can help healthcare workers identify patients at high risk of deterioration, high rate of mortality, and high rate of morbidity.