Background/Objectives: Spontaneous intracranial hemorrhage (sICH) is a life-threatening condition with high in-hospital mortality rates. Prognostic evaluation remains challenging, and biomarkers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), glucose-to-lymphocyte ratio (GLR), and high-sensitivity troponin-I (hs-cTn-I) have been studied for their potential prognostic significance. This study aimed to evaluate the role of hs-cTn-I, NLR, PLR, LMR, and hematoma volume in predicting prognosis in sICH patients. Methods: This retrospective study included 49 adult patients (>18 years) admitted between January 2021 and January 2024 with sICH and hematoma volume >30 mL. All patients underwent surgery within 24 h of admission. Laboratory data, including hs-cTn-I levels and hematological indices, were collected. The hematoma volume was measured using the ABC/2 method. Patients were divided into survival and mortality groups. Statistical analyses were performed using SPSS, with p < 0.05 considered significant. Results: Of the 49 patients, 24 (49%) died. Admission hs-cTn-I levels showed no significant difference between groups, but levels on days 7 and 30 were significantly higher in the mortality group (p < 0.001). ROC analysis revealed hs-cTn-I levels on day 30 had better prognostic performance (AUC: 0.89, cut-off: 46 ng/mL, sensitivity: 76%, specificity: 88%). The hematoma volume and admission hematological indices (NLR, PLR, LMR, SII, and GLR) were not significantly associated with prognosis. Conclusions: Elevated hs-cTn-I levels, particularly on days 7 and 30, were significant predictors of in-hospital mortality in sICH patients. While admission hematological indices and hematoma volume lacked prognostic value, hs-cTn-I may serve as a valuable biomarker for risk stratification in clinical practice. Further multicenter studies with larger cohorts and multivariate analyses are needed to validate these findings.