Introduction: Hydroxychloroquine (HCQ) is an antimalarial drug that received worldwide news and media attention in the treatment of patients with coronavirus disease 2019 (COVID19). This drug was used on the basis of its antimicrobial and antiviral properties despite lack of definite evidence of clinical efficacy. In this study, we aim to assess the efficacy and safety of using HCQ in treatment of patients with COVID-19 who were admitted in King Salman Specialist Hospital, at Hail, KSA. rnMethods: We conducted a retrospective cohort study on a random sample of patients admitted with COVID-19 between 1 April and 31 July 2020. The study was conducted in King Salman Specialist Hospital, Hail, KSA. Data was extracted from the medical records. The primary endpoint was the requirement of noninvasive ventilation, intubation, or death. Secondary endpoint was length of hospitalization for survivors and readmissions. Three methods of analysis were used to control for confounding factors: logistic multivariate regression, propensity score adjusted regression, and matched propensity score analysis. rnResults: A random sample of 753 patients were included, 348 of whom received HCQ (treatment group) and 405 did not receive it (control group). Our results showed that HCQ did have a significant effect on primary outcomes due to COVID-19 infection when compared to controls after adjusting (P = 0.011). Co-administration of aspirin and dexamethasone had also effect on primary outcomes (P = 0.011). Morbid Obesity was associated with increased risk of primary and secondary outcome (P = 0.005) rnHydroxochloroquine was not associated with QT prolongation or cardiac arrhythmia. rnConclusion: Our results showed some beneficial effect of using hydroxychloroquine on the outcome of patients with COVID-19, and also aspirin and dexamethasone. Obesity however, in combination with diabetes mellitus, is a significant cardiovascular risk in patients with COVID 19 infection