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To investigate the value of platelet-to-lymphocyte ratio (PLR) and fibrinogen (Fib) in evaluating the severity of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the elderly. Forty elderly patients with AECOPD admitted to the Department of Respiratory and Critical Care Medicine of our hospital from January 2020 to December 2022 were selected as AECOPD group. According to the severity of the disease, they were divided into grade I (n=9), grade II (n=17) and grade III (n=14). Forty elderly patients with stable chronic obstructive pulmonary disease (SCOPD) were selected as SCOPD group. The general data, PLR and Fib levels of each group were compared. Logistic regression model was used to analyze the independent risk factors of elderly AECOPD. The predictive value of PLR and Fib for elderly AECOPD was evaluated by receiver operating characteristic curve (ROC). The levels of PLR and Fib in peripheral blood of AECOPD group were higher than those of SCOPD group (P<0.05). The levels of PLR and Fib in elderly patients with AECOPD of different clinical grades were compared, and the differences were statistically significant (P<0.05). Grade III was the highest, followed by grade II, and grade I was the lowest. Logistic regression analysis showed that the odds ratios of PLR and Fib were 1.857 and 2.094, respectively, which were independent risk factors for AECOPD in the elderly (P<0.05). ROC curve analysis showed that the area under the curve of PLR, Fib and their combination in predicting AECOPD in the elderly was 0.862, 0.853 and 0.948, respectively, and the combination of the two had the highest predictive value (sensitivity 87.50 %, specificity 95.00 % ). The levels of PLR and Fib in peripheral blood are related to the severity of AECOPD in elderly patients, and the combination of the two has the highest diagnostic value for AECOPD in elderly patients. [ABSTRACT FROM AUTHOR]