Acute and severe exacerbations of COPD can be life-threatening and increase the decline in respiratory function, requiring hospitalization in the intensive care unit (ICU) .The aim of our study was to determine the predictive factors of hospitalization of COPD patients in the ICU.It is a retrospective study about 270 patients with COPD hospitalized for acute exacerbation(AE) at our pneumology department of.Farhat Hached Hospital in Tunisia during the year 2022. We compared between patients who had never been hospitalized in intensive care (218 patients: G1) with patients with a history of hospitalization in intensive care (52 patients: G2).Results: G2 patients were more symptomatic (dyspnea mMRC > 2: 68.2% vs 46.8%,p=0.004), had more exacerbations (p=0.03), had a lower post-bronchodilator(PB) FEV1(47% vs 38%,p=0.006) and a higher arterial CO2 pressure(PCO2) during AE(70.5 vs 60 mmHg ,p=0.01). In univariate study, the predictive factors for ICU hospitalization were: history of stroke (p=0.034), frequent hospitalization for COPD exacerbation (p<0.001), and number of exacerbations >2/year (p=0.04), being classified according to GOLD 2022, group D (p<0.001) and Gold stage 4 (p=0.001). Patients with chronic heart failure (p=0.02) and long-term oxygen therapy (p<0.001) were at risk for severe exacerbation. Patients who were taking their treatments according to international recommendations (p=0.009) and who were adherent to their treatment had a lower risk of being hospitalized in the intensive care unit. In the multivariate study, the factors considered were: History of hospitalizations for exacerbation, dyspnea>2Mmrc, FEV1 PB, CPC and hypercapnia at admission.