Objective To investigate the expression and clinical significance of serum HA level in patients with acutespontaneous intracerebral hemorrhage (ICH). Methods 120 patients with acute spontaneous intracerebral hemorrhage admitted in our hospital between April 2016 and August 2017 were enrolled as subjects. At the same time, 102 healthy subjects were selected as the control group. The patients were graded 3 months after discharge using the modified Rankin scale. The patients were divided into favorable prognosis group (FPG) and poor prognosis group (PPG), according to the score. The HA level expression and clinical significance of the two groups were observed and analyzed. Results At admission,the HA level in the ICH group was significantly higher than that in the control group (P＜0.05). The age and hematoma volume of FPG were significantly lower than those of PPG (P＜0.05). After admission, the NIHSS（National Institutes of Health Stroke Scale） scores in FPG were significantly lower than those in PPG (P＜0.05). The NIHSS score was positively correlated with HA expression at admission (r=0.573, P＜0.001). After 3 months of treatment, the mRS score of FPG was significantly lower than that of PPG (P＜0.05); the mRS score was positively correlated with HA expression (r=0.757, P＜0.001). The NIHSS score and HA level of FPG were significantly lower than those of PPG (P＜0.05). Univariate analysis showed that the age, hematoma volume, HA level, NIHSS score, and mRS score of the favorable prognosis group were significantly different from those of the poor prognosis group (P＜0.05). Logistic regression analysis showed that age, hematoma volume, HA level, NIHSS score and mRS score wereassociated with poor prognosis in patients with ICH. Conclusion The expression of serum HA level in patients with acutespontaneous ICH is abnormally increased with serious condition and poor prognosis. Therefore, high expression of serum HA at admission can be used as a predictor of poor prognosis.