Background/Objectives: Portal vein thrombosis (PVT) is a clinically significant condition in which early risk stratification remains challenging, particularly in emergency settings where rapid decision-making is required. This study aimed to evaluate the prognostic value of the Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and the Model for End-Stage Liver Disease (MELD) score in predicting the need for intensive care in patients with PVT. Methods: A retrospective analysis was conducted on adult patients (>18 years) diagnosed with PVT in the emergency department between January 2018 and December 2024. A total of 29 patients meeting the inclusion and exclusion criteria were included. Demographic characteristics, laboratory parameters, Intensive Care Unit (ICU) admission status, and 90-day mortality were analyzed. The sensitivity and specificity of MELD, SII, and SIRI for predicting ICU admission were calculated. Non-normally distributed variables were expressed as median (interquartile range, IQR) and compared using the Mann–Whitney U test. Results: The mean age of patients was 60.5 ± 16.2 years, and 18/29 (62.1%) were male. ICU admission was required in 9/29 (31.0%) of cases. MELD score (median 18.7 [11.0–21.9] vs. 7.9 [6.7–13.5], p = 0.003), bilirubin (median 2.4 [1.0–4.2] vs. 0.7 [0.4–1.1], p = 0.016), and SIRI (median 6.4 [2.3–21.3] vs. 1.4 [0.6–9.3], p = 0.038) were significantly higher in ICU-admitted patients. MELD score showed 66.7% sensitivity and 95% specificity, while SIRI had 88.9% sensitivity and 55% specificity for ICU prediction. Conclusions: MELD score, bilirubin, and SIRI are significantly associated with ICU admission in PVT patients. Their integration into emergency department protocols may assist in early risk stratification and resource allocation.