Background: In patients with acute aggravation of chronic obstructive pulmonary disease, the predictive relevance of amino terminal pro-brain natriuretic peptide levels has not been clearly demonstrated. Amino terminal pro-brain natriuretic peptide levels in patients with acute exacerbation COPD who need ICU hospitalisation were evaluated in this study. Methods: From May 2020 to March 2021, 80 patients with acute aggravation of chronic obstructive pulmonary disease were enrolled in this prospective observational research at Benha University Hospital's chest ICU. The following information was gathered: demographics, use of noninvasive mechanical ventilation, necessity of invasive mechanical ventilation, level of amino terminal pro-brain natriuretic peptide, duration of mechanical ventilation, intensive care unit and hospital stay, success in weaning, and mortality rates. The research comprised a total of 80 individuals (74 men and 6 women). Participants ranged in age from 53 to 84 years on average. Noninvasive mechanical ventilation success was associated with lower levels of the amino terminal pro-brain natriuretic peptide than noninvasive mechanical ventilation failure (320.50 – 991.90). In addition, patients who required invasive mechanical breathing assistance had considerably greater levels of the amino terminal pro-brain natriuretic peptide (1004.90 – 1188.30, p=0.001) than those who did not. Patients on IMV who saw an increase in their amino terminal pro-brain natriuretic peptide levels had a considerably greater death rate (12.5 percent ,). Conclusion The measurement and trend monitoring of amino terminal pro-brain natriuretic peptide may be a valuable asset in predicting mortality, noninvasive mechanical ventilation, weaning success, and the need for invasive mechanical ventilation in cases of acute exacerbation of chronic obstructive pulmonary disease requiring mechanical ventilation.