Background: Erysipelas is an acute, recurrent infectious disease caused by Group A β-hemolytic streptococcus. Recurrence occurs in 12–29% of patients, and complications in approximately 31%. International studies indicate that age, sex, and skin conditions are key factors influencing complications and recurrence. In Mongolia, the incidence of erysipelas has not steadily declined, and there is a lack of studies investigating clinical and laboratory predictors of complications and recurrence. Aim:: This study aimed to investigate clinical and laboratory predictors of complications and recurrence among erysipelas cases registered in Mongolia. Materials and Methods: A retrospective cross-sectional study design was employed. A total of 165 patients hospitalized with a diagnosis of erysipelas at the National Center for Communicable Diseases between 2020 and 2024 were randomly selected. Data were collected based on the “Clinical Guidelines for Erysipelas.” Statistical analysis was performed using SPSS-26, and ROC curve analysis along with regression models were used to determine risk and predictive factors. A p-value <0.05 was considered statistically significant. Results: The mean age of participants was 50.4±14.2 years; 76.5% were female, and 32.1% were herders. Recurrence was observed in 55.1% of patients (42.8% repeated episodes, 57.2% recurrent cases), and complications occurred in 10.3%. Among patients with complications, lesions were most commonly located on the face (41.2%) and predominantly presented as erythematous-bullous forms (70.6%). The neutrophil-to-lymphocyte ratio was 7.1 (AUC: 0.85, 95% CI: 0.79–0.91, p=0.001), and the systemic inflammatory response index was 3.9 (AUC: 0.93, 95% CI: 0.88–0.98, p=0.001), indicating high levels. Multivariable regression analysis showed that risk factors for complications included age >45 years (aOR=1.8, 95% CI: 1.2–2.7, p=0.004), female sex (aOR=2.8, 95% CI: 1.7–4.6, p=0.001), and occupation (herder) (aOR=2.6, 95% CI: 1.3–5.4, p=0.001). Chronic tonsillitis was significantly associated with recurrence (OR=3.8, 95% CI: 2.5–5.7, p=0.001). Cox regression analysis demonstrated that each additional year of age increased the risk of complications by 2% (HR=1.02, 95% CI: 1.01–1.03, p=0.003), while the presence of chronic tonsillitis increased the risk of recurrence by 7.69 times (HR=7.69, 95% CI: 5.15–11.49, p=0.001). Conclusion Cellular ratio indicators in erysipelas are useful for assessing inflammatory activity and disease progression. Age, sex, occupation, and the presence of chronic tonsillitis significantly influence the risk of complications and recurrence in erysipelas.