Abstract Elevated aspartate aminotransferase-to-alanine aminotransferase ratio (De Ritis) has been associated with cardiovascular diseases and mortality. The clinical significance of De Ritis in the prognosis of hemorrhagic stroke has yet to be established. We aimed to investigate the associations between De Ritis levels and clinical outcomes in aneurysmal subarachnoid hemorrhage (aSAH). We retrospectively reviewed all aSAH patients admitted to their institution between January 2015 and September 2022 in the LongTEAM registry. Patients with aSAH were divided into four groups by quartiles of De Ritis, and two groups according to De Ritis 2. We speculated that elevated De Ritis was associated with higher risk of unfavorable functional outcome at discharge, MACE, DCI and anemia. Given that postoperative De Ritis levels could help to identify high-risk patients with aSAH, these findings are of clinical relevance.