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To evaluate the ability of measures of coagulopathy and acidosis to predict complications. We hypothesize that increased coagulopathy and acidosis over the first 60 hours of hospitalization will result in increased rates of infection and mortality.Prospective, observational.Level 1 trauma center.Three hundred seventy-six skeletally mature patients with an Injury Severity Score greater than 16, who were surgically treated for high-energy fractures of the femur, pelvic ring, acetabulum, and/or spine.Data included measures of acidosis, pH, lactate, and base excess, and measures of coagulopathy, Prothrombin (PT), Partial Throunboplastin Time (PTT), International Normalized Ratio (INR), and platelets. Complications including pneumonia, deep venous thrombosis, pulmonary embolism, infection, organ failure, acute renal failure, sepsis, and death were documented.Acidosis was common on presentation (88.8%) and decreased over 48 hours (50.4%). Incidence of coagulopathy increased over 48 hours (16.3%–34.3%). Coagulopathy on presentation was associated with complications (54.0% vs. 27.7%) including pneumonia, acute renal failure, multiple organ failure, infection, sepsis, and death. Acidosis was associated with complications if it persisted later in the hospital course.Coagulopathy on presentation is a stronger predictor of complications, sepsis, and death than acidosis. During the first 48 hours, unresolved acidosis increased the risk of complications and sepsis. Complications were most related to higher Injury Severity Score.Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.