<p>The association between the Endothelial Activation and Stress Index (EASIX) and severe consciousness disorder (SCD), as well as 30-day in-hospital mortality (IHM) among intensive care unit (ICU) patients with non-traumatic intracerebral hemorrhage (ICH) has not been well characterized. This study evaluated the relation of EASIX to these outcomes in this population. Adult ICU patients with non-traumatic ICH were identified from MIMIC-IV 3.1. Outcomes included SCD and 30-day IHM. Associations between EASIX and outcomes were assessed using Cox proportional hazards models. Potential non-linear relationships were examined through restricted cubic spline (RCS) analyses. Subgroup analyses were performed to assess consistency across patient subgroups. A random forest (RF) model was constructed, and SHapley Additive exPlanations (SHAP) values were used to quantify and rank variable importance. 1,010 ICU patients with non-traumatic ICH were included. After adjustment for relevant confounders, higher EASIX values were associated with increased risks of SCD and 30-day IHM (hazard ratio (HR): 1.184; 95% confidence interval (CI): 1.073-1.307). RCS analysis demonstrated an approximately linear association after adjustment for potential confounders. Subgroup analyses yielded consistent findings across predefined patient strata. SHAP analysis identified baseline Glasgow Coma Scale (GCS) score as the most influential variable, followed by mechanical ventilation (MV) status and partial pressure of oxygen (PaO₂). The contribution of EASIX to the model was positive. EASIX was independently associated with SCD and 30-day IHM among ICU patients with non-traumatic ICH. It may serve as a useful prognostic indicator for risk stratification in this critically ill population.</p><p><b>Trial registration: </b>Not applicable.</p>