Objective To investigate the relationships between plasma levels of interleukin (IL)-6, IL-17, transforming growth factor-β1 (TGF-β1), tissue factors (TF), tissue factor pathway inhibitor (TFPI), coagulation pictures and multiple organ dysfunction syndrome (MODS) in patients with hemorrhagic fever with renal syndrome (HFRS), and to direct the clinical treatment. Methods Twenty three hospitalized (from January 2010 to April 2012) cases with HFRS were divided into two groups according to the severity of illness, including moderate group (n=12) and severe group (n=11). And 20 healthy individuals were collected as control group. The dynamic changes of IL-6, IL-17, TGFβ-1, TF, TFPI, coagulation function, D-dimer (D-D), creatinine kinase-MB (CK-MB), blood urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and platelet count were compared among different phases and different groups. The data was analyzed with independent-samples t test for two group comparison, variance analysis for three groups or above, and Pearson correlation analysis for the correlation of each item. Results During the acute phase of HFRS, the plasma levels of IL-6, IL-17, TGF-β1, TF, and TF/TFPI ratio were significantly increased, activated partial thromboplastin time (APTT) was notably prolonged, the prothrombin time international normalized ratio (INR) and D-D were markedly increased, while fibrinogen (FN) and platelet count were considerably decreased as compared with control group. At febrile stage, the plasma TF level (36.54±8.59) ng/L and TF/TFPI ratio 3.27±0.65 in severe group were both significantly higher than moderate group (26.38±7.11) ng/L and 2.61±0.57, t=2.964 and 2.480, respectively, both P<0.01). The change curves of IL-6, IL-17 and TF/TFPI ratio were similar to those of APTT, D-D, BUN, ALT and CKMB, while those were contrary to that of platelet count. Plasma TF level was positively correlated with BUN, CKMB, AST, APTT, INR, and D-D levels (r = 0.418, 0.519, 0.440, 0.495, 0.410 and 0.429, respectively, all P<0.01), while negatively correlated with platelet count (r=-0.431, P<0.01). Conclusions The increased levels of IL-6, IL-17, TF/TFPI ratio, INR and D-D, prolonged APTT, and decreased levels of FN and platelet counts in the acute phase of HFRS provide evidences for the systemic inflammation reaction, capillary injury, the activation of platelet and coagulation system, which might be the main cause leading to multiple organ dysfunction syndrome. Therefore, it is essential to wisely use antiviral agents, anticoagulants and fluid resuscitation in the early stage of the disease. Key words: Hemorrhagic fever with renal syndrome; Interleukin-6; Interleukin-17; Transforming growth factor beta1; Tissue factor; Tissue factor pathway inhibitor; D-dimer; Multiple organ dysfunction syndrome