Chronic obstructive pulmonary disease (COPD) stands as one of the leading causes of mortality worldwide. Acute exacerbations of COPD (AECOPD) lead to rapid respiratory function decline and worsened disease status. Despite recent studies, the ability of the neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with COPD remains controversial. It remains controversial whether NLR can predict clinical outcomes in hospitalized patients with AECOPD. Therefore, this study was conducted to investigate the predictive value of NLR for severity, adverse outcomes in hospitalized patients with AECOPD, and predicting treatment response in patients with AECOPD