Abstract: Objective To analyze the nutritional status of patients with acute exacerbation of COPD(AECOD) and its relationship with acute exacerbation so as to provide guidance for evaluating nutritional status and acute exacerbation risk in the future clinical work. Methods The clinical data of 135 patients with AECOPD admitted to the Respiratory Department of our hospital from September 2018 to May 2019 were analyzed retrospectively. Patients were divided into acute exacerbation low risk group(n=20) and high risk group(n=115). The age, ideal body mass percentage(IBW%), body mass index(BMI), hemoglobin(Hgb), serum albumin(ALB), serum prealbumin(PA), mMRC and their relationship with acute exacerbation was analyzed. Results ①The sensitivity of each nutritional index ideal to evaluate nutritional status of AECOPD patients was different, the proportion of undernutrition was 22.22%(30/135) of IBW%, 28.15%(38/135) of BMI, 2.96%(4/135) of Hgb, 57.03%(77/135) of ALB, and 43.70%(59/135) of PA respectively. ② There were statistically significant differences in the number of patients with respiratory failure(1 vs. 43, χ²=8.136, P=0.004), the level of ALB, PA and the index of acute exacerbations per year between the low-risk group and the high-risk group(all P<0.05). ③ There were statistically significant differences in PA and the index of acute exacerbations per year between the non-respiratory failure group and the respiratory failure group(all P<0.05). ④ The level of PA was negatively correlated with the index of acute exacerbations per year(P<0.05), while the mMRC score was positively correlated with the index of acute exacerbations per year(P<0.05). Conclusion PA levels can effectively assess the nutritional status of patients with AECOPD and predict the risk of acute exacerbation.