Further multivariate Cox regression analysis demonstrated that antibiotic usage (HR = 0.275; 95% CI: 0.104, 0.726; p = 0.009) and serum DBIL (HR = 1.135, 95% CI: 1.038, 1.241; p = 0.006) remained significantly associated with moderate-to-severe TR after adjusting for confounders, including age, MR, AF type, NYHA classification, PASP, TBIL, and BNP. Here, NPPB is linked to atrial fibrillation.