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Background: The value of Modified DECAF Score as a clinical prediction tool that can accurately risk stratify all patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is needed to be assessed. Aim: The aim of this study is to evaluate the prognostic effect of the Modified DECAF score in predicting outcomes in AECOPD. Materials and Methods: A hospital-based descriptive type of observational study done on 160 patients admitted with AECOPD at the Institute of Respiratory Diseases, SMS Medical College, Jaipur. Modified DECAF score was calculated for each patient, and the individual parameters used in calculating the score were recorded. Modified DECAF score has five variables (baseline dyspnoea extended Medical Research Council Dyspnea Grade 5a or 5b, Eosinopenia (<50 cells/mm3), Consolidation, Acidemia (pH < 7.30), frequency of hospitalisations in last 1 year (2 or more), a maximum score of 6.Results: Patients could be stratified according to mortality rates observed with Modified DECAF scores into low risk (scores 0–2), intermediate risk (score 3) and high risk (scores 4–6) groups. Mortality was close to 70% in the high-risk group; it was about 7% in the intermediate risk group, whereas no deaths were recorded in the low-risk group. Conclusion: We concluded that the Modified DECAF score is sensitive and specific in predicting in-hospital mortality in AECOPD patients. Further research is required to quantify its impact on clinical practice, for example, in the identification of patients for palliative care or early supported discharge services or for escalation of therapy.