**6. Conclusion**

#### **6.1 Investigate the significance of liver trauma and prognostic factors in severely injured patients**

In our opinion, unstable patients should be identified by the following parameters: 1) location of the source of bleeding, i.e., free fluid in the abdomen in the initial ultrasound, if need be with an increase in the course of action; 2) volume loss, i.e., substitution is required for hemodynamic stability when systolic blood pressure falls below 80 - 90 mmHG; 3) signs of systemic hypoperfusion with negative base excess and pH and where applicable with an initial hemoglobin under 8 mg/dl with signs of consumptive coagulopathy.

Knowledge of the additional dangers documented here as they can arise from a liver injury and may possibly be positively affected by e.g. a specific coagulation treatment and an early substitution of ECs. The immunological changes to be expected from a liver injury in the meantime may possibly even reinforce the frequently described post-trauma immunosuppression.
