ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Heart Valve Disease
This article is part of the Research TopicTricuspid regurgitation - Time to assess more than the prognosisView all 7 articles
Serum Direct Bilirubin Predicts Severe Tricuspid Regurgitation in Atrial Fibrillation
Provisionally accepted
- 1Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- 2Zhongshan Hospital Fudan University, Shanghai, China
- 3Shanghai Pudong New District Zhoupu Hospital, Pudong, China
- 4Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
- 5Shanghai University of Medicine and Health Sciences, Shanghai, China
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Aims: Moderate-to-severe tricuspid regurgitation (TR) often coexists with atrial fibrillation (AF) and is associated with poor prognoses. Although inflammation is elevated in TR patients, whether bilirubin predicts moderate-to-severe TR in AF remains unclear. This study aimed to evaluate serum bilirubin as an early diagnostic marker for TR in AF. Method and Results: We enrolled 344 AF patients (2020–2023) and collected clinical data, including diagnosis, blood tests, medication history, and echocardiography (TTE) parameters. Patients were grouped by TR severity (AF with vs. without moderate-to-severe TR) or antibiotic use (users vs. non-users). After adjusting for confounders, univariate and multivariate Cox regression analyzed variable associations with TR occurrence. ROC analysis assessed DBIL's predictive accuracy for TR, and Kaplan-Meier curves depicted cumulative 48-month TR incidence in patients with DBIL >3.5 µmol/L. Patients with moderate-to-severe TR had higher DBIL (5 vs. 3 µmol/L, p<0.001), TBIL, BNP, and γ-GGT. Multivariate Cox regression showed elevated DBIL independently predicted TR (HR=1.104, p=0.039). ROC analysis identified DBIL ≥3.5 µmol/L as an optimal cutoff for distinguishing TR (AUC=0.846, sensitivity 91.2%, specificity 68.8%). Among patients with DBIL >3.5 µmol/L, antibiotic use reduced TR risk (HR=0.214, p<0.001). Conclusions : Serum DBIL levels serve as a potential early diagnostic marker for moderate-to-severe TR in AF patients, and anti-infective therapy lowers TR incidence.
Keywords: Moderate-to-SevereTricuspidRegurgitation1, AtrialFibrillation2, DirectBilirubin3, antibiotic use4, microbial translocation5
Received: 25 Aug 2025; Accepted: 07 Nov 2025.
Copyright: © 2025 Wang, Zou, Lin, Wang, Wu, Zhou and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yao-sheng Wang, wangyaosheng@xinhuamed.com.cn
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