Background Acute spontaneous intracerebral hemorrhage (sICH) is a morbid and deadly form of stroke. The lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammation index (SII) are two novel markers of systemic inflammation. We aimed at investigating the predictive value of LMR and SII in patients with sICH. Methods We retrospectively evaluated patients who were hospitalized for sICH at the First Affiliated Hospital of Zhengzhou University from September 2019 to July 2020. According to the 3-month modified Rankin Scale (mRS) score, we considered a good prognosis group (mRS: 0–2) and a poor prognosis group (mRS ≥ 3 or death). A logistic regression analysis was used to identify the factors affecting the prognosis at 3 months. Results A total of 171 patients with sICH were enrolled. A lower LMR measured at 24 h of admission was an independent predictor of 3-month prognosis (OR: 0.392, 95% CI 0.281–0.547, p < 0.001). A lower GCS score measured at 24 h after admission was an independent predictor of 3-month prognosis (OR: 0.821, 95% CI 0.747–0.902, p = 0.023). A previous heart disease was an independent predictor of 3-month prognosis (OR: 6.307, 95% CI 1.381–30.196, p = 0.021). SII measured at 24 h of admission was not an independent predictor of 3-month prognosis. Combining the results obtained by each indicator, the final curve showed an AUC of 0.850, indicating a satisfactory predictive performance. The receiver operating characteristic curves showed that the sensitivity of LMR was 93.07% (95% CI 86.2–97.2), while the specificity was 52.86% (95% CI 40.6–64.9). The sensitivity of GCS score was 76.77% (95% CI 67.2–84.7), while the specificity was 60.29% (95% CI 47.7–72.05). The sensitivity of SII was 91.09% (95% CI 83.8–95.8), while the specificity was 37.14% (95% CI 25.9–49.5). The DeLong test showed that the predictive value of LMR was higher than SII (p = 0.0001). Conclusions In patients with sICH, LMR showed an independent predictive value for anticipating 3-month prognosis.