Abstract： Objective:To assess the relationship between red blood cell distribution width (RDW) and prognosis of chronic obstructive pulmonary disease (COPD).Methods:Databases of PubMed, Embase, Cochrane, Web of science were searched from inception to October 2022, and meta analysis was performed with Revman 5.4 software and Stata 17.0 software.Results:A total of 243 papers were initially reviewed, 20 papers in compliance with the criteria were finally included upon screening.Meta analysis results showed that RDW value in COPD patients was higher than that in the healthy population ( MD=-0.29, 95% CI: -0.32--0.26, Z=17.94, P<0.05), RDW in acute exacerbation of COPD (AECOPD) patients was higher than that in COPD patients ( MD=-0.71, 95% CI: -1.20--0.22, Z=2.84, P<0.05), COPD and AECOPD patients with adverse outcomes had higher RDW than COPD and AECOPD patients without adverse outcomes ( MD=-1.61, 95% CI: -2.12--1.10, Z=6.18, P<0.05).Subgroup analysis showed that RDW was significantly higher in dead patients compared with surviving patients ( MD=-1.55, 95% CI: -2.03--1.07, Z=2.84, P<0.05), and RDW in patients with severer symptoms was significantly higher when compared to that in patients with milder symptoms ( MD=-1.62, 95% CI: -2.86--0.38, Z=2.56, P<0.05). Conclusions:RDW is likely to be a valid predictor of COPD and has a more important role in poor prognosis.