Objective: To investigate the role of nesfatin-1 in patients with aneurysmal subarachnoid hemorrhage (aSAH). Method: A retrospective study was performed. There were 97 aSAH patients treated in Shenzhen People's Hospital from October 1, 2014 to December 30, 2016 in this study. Patient demographics, neurological presentations, in hospital complications, and clinical outcomes were recorded in detail. Serum samples on admission were collected and quantitative assay techniques were used to detect the serum level of nesfatin-1. The association between nesfatin-1 and the clinical outcome was analyzed using a multivariate regression analysis. In addition, we used a receiver operating characteristic (ROC) curve investigate the value of nesfatin-1 in predicting poor outcomes. Results: Among the 97 included patients, 72 patients achieved good outcomes and 25 patients achieved poor outcomes. The serum concentration of nesfatin-1 in patients with poor outcomes was higher than patients with good outcomes. After analyzing with multivariate regression analysis, we found that GCS, Hunt Hess III-V, DCI, and an elevated level of nesfatin-1 were significantly associated with poor outcome. The area under the ROC curve of Fisher grade, GCS, Hunt Hess and nesfatin-1 were 0.721, 0.748, 0.808, and 0.852, respectively. Conclusion: Elevated serum levels of nesfatin-1 significantly correlated with the clinical severity of aSAH patients. Serum nesfatin-1 in aSAH patients might be a potential biomarker for predicting the outcome of patients with aSAH.