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Background and aims The relationship between serum lipid level and clinical outcome after spontaneous intracerebral hemorrhage (ICH) remains controversial. We sought to evaluate the association of serum lipid levels with clinical outcomes in patients with ICH. Methods Data on consecutive patients hospitalized with spontaneous ICH were prospectively collected from May 2005 to May 2018 and retrospectively analyzed. Following clinical and demographic data, age and gender, risk factors, serum lipid levels [total cholesterol, triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol] and the outcomes were analyzed. Results A total of 1451 patients with ICH (mean age, 60.41 ± 12.3 years; 32.6% women) was evaluated. Although admission TG levels were associated with the outcomes at hospital discharge and 3 months in initial univariate analyses, the former association did not retain its statistical significance in multivariate logistic regression analyses adjusting for potential confounders. However, lower admission TG levels were independently associated (p = 0.045) with a higher likelihood of 12-month unfavorable outcomes (odds ratio 0.91, 95% confidence interval 0.83-0.99) in multivariate logistic regression models. Conclusions Low TG levels at hospital admission were an independent predictor for unfavorable long-term outcomes in patients with spontaneous ICH. The exact mechanisms of the association need further investigations.