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Introduction: Dengue virus (DENV) affects over half the world's population in 112 countries, and dengue fever (DF) is the second largest arthropod borne infectious global hazard after malaria with complications like Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), accounting for significant morbidity and mortality world-over. Pakistan is significantly affected with DENV infection and to-date no study identifying risk factors associated with development of severe complications of DF has been done. Methods: 997 confirmed cases of DF were collected from a tertiary care hospital in Lahore, Pakistan and their clinical and biochemical data were collected. Univariate, multivariate and logistics regression analysis was performed to identify risk factors associated with development of DHF and DSS. Results: Bleeding OR 70.7 (CI 38.4-129.9), deranged liver function test OR 1.9 (CI 0.97-0.99), presence of urinary red blood cells OR 1.4 (95%CI 0.179-0.900) and presence of urinary protein OR 1.1 (95%CI 0.191-0.974) were related to development of DHF and DSS. Discussion: Severe Dengue, like DHF and DSS can be predicted by the presence of clinical and biochemical factors like signs of bleeding, deranged liver function test, presence of urinary red blood cells and urinary protein; so that the patients at high risk for complication be identified early and started on treatment timely. Conclusion: Predictors of severe dengue are identified in this study but further large scale multi-centered studies are needed for better interpretation. [ABSTRACT FROM AUTHOR]