Objective To investigate the expression and clinical significance of serum sphingosine-1- phosphate （S1P） in patients with hemorrhagic stroke. Methods A total of 124 patients with hemorrhagic stroke who underwent surgical treatment in our hospital from January 2016 to January 2019 were selected， including 28， 49， and 47 mild， moderate and severe cases respectively， with 88 cases of good prognosis and 36 cases of poor prognosis. A total of 86 healthy people collected by the physical examination center of this hospital during the same period were selected as controls. Enzyme-linked immunosorbent assay was used to detect the expression of S1P in serum. A logistic multivariate regression model was established to analyze the factors that affect the prognosis of patients. The value of S1P in predicting prognosis were analyzed by receiver operating characteristic （ROC） curve. Results The serum S1P concentration of patients with hemorrhagic stroke was （304.34±86.09） ng/ml， which was lower than that of healthy people ［（385.89±98.32）ng/ml， P＜0.05］. The serum S1P concentrations of patients with mild， moderate and severe hemorrhagic stroke were （331.03±100.23） ng/ml， （300.34±78.58） ng/ml， （287.70±66.89） ng/ml， respectively. The results of univariate analysis showed statistical differences between groups （F=24.012， P ＜ 0.05）. The serum S1P concentration decreased as the disease getting worse. Compared with patients with good prognosis， patients with poor prognosis had higher age， hematoma volume， and C-reactive protein levels， and lower S1P levels as well as lower GCS scores （P＜ 0.05）. The results of multivariate analysis showed that age （OR=1.897）， hematoma volume （OR=3.903）， GCS scores （OR=2.003）， C-reactive protein （OR=2.014）， serum neuron specific enolase （OR=4.231） and S1P （OR=0.896） were independent factors affecting the prognosis of patients with hemorrhagic stroke （P＜ 0.05）. The area under the ROC curve （AUC） of S1P predicting poor prognosis of patients with hemorrhagic stroke was 0.910 （95%CI： 0.821-0.968）， and the sensitivity and specificity were 82.35% and 90.12%， respectively. S1P predicted AUC higher than C-reactive protein （AUC=0.843）. Conclusions The expression level of serum S1P in patients with hemorrhagic stroke is reduced， which is related to the severity of the disease. SIP is helpful for early prediction of clinical prognosis.