Objective To explore the clinical characteristics and related risk factors of patients with frequent acute exacerbation of chronic obstructive pulmonary disease.Methods The clinical data of patients hospitalized for acute exacerbation of COPD in the First Affiliated Hospital of Xinxiang Medical University from December 2021 to December 2022 were collected. The frequency of acute exacerbation, oxygen therapy, drug therapy and health status within 1 year after discharge were followed up. Patients with moderate to severe exacerbations of COPD ≥2 times in 1 year were defined as frequent exacerbations (study group), and patients with moderate to severe exacerbations of COPD <2 times in 1 year were defined as non-frequent exacerbations (control group). The factors with significant differences between the two groups (P<0.01) were included in the modified Poisson regression analysis to screen out the independent risk factors related to frequent acute exacerbations of chronic obstructive pulmonary disease. The independent risk factors of frequent acute exacerbations of COPD were included in the ROC curve analysis, the probability of the five indicators and their combined prediction was calculated, and the best cut-off value of each indicator was calculated. Results The factors with significant differences (P<0.01) between the two groups in univariate analysis were included in the modified Poisson regression analysis, and the results showed that the RDW-CV was higher (P=0.014, RR=1.088, 95%CI: 1.018~1.164); BMI was lower (P=0.007, RR=0.945,95%CI: 0.908~0.985); combined with type 2 diabetes mellitus (P=0.012, RR=1.516, 95% CI: 1.097~2.095); the GOLD grade of lung function was higher (P<0.001, RR=1.518, 95%CI: 1.219~1.890); older age (P=0.004, RR=1.021, 95%CI: 1.006~1.035) were independent risk factor for frequent exacerbations of COPD. The independent risk factors of frequent acute exacerbations of COPD were included in ROC curve analysis, and the results showed that lower BMI, GOLD grade 3 and 4, age >65.5 years, RDW-CV>13.25%, combined with type 2 diabetes mellitus were the independent risk factors of frequent acute exacerbations of COPD. The area around the ROC curve and the coordinate axis (AUC) of the combined prediction of the five indicators was 0.799. The sensitivity and specificity calculated by the maximum Youden index were 74.8% and 72.5%, respectively. Conclusion Lower BMI, lung function GOLD3 and GOLD4, age >65.5 years, RDW-CV>13.25%, and combined with type 2 diabetes mellitus are independent risk factors for frequent acute exacerbations of COPD. The combined prediction based on BMI, GOLD classification of lung function, age, RDW-CV and type 2 diabetes mellitus has a good predictive value for the frequent acute exacerbation events of COPD in the future