The Impact of a Traumatic Brain Injury Within 1 Year of COVID-19 Infection: A Propensity-Match Analysis

Introduction: Adverse outcomes relating to SARS-CoV-2 (COVID-19) infection may be influenced by comorbidities and past medical history. The relationship between the prevalence of recent TBI and adverse outcomes following COVID-19 infection remains poorly understood. This study aims to identify whether patients with recent TBI face increased risk of mortality and adverse outcomes associated with COVID-19.

Methods: We identified patients in the TriNetX United States Collaborative Network with recent TBI within 1 year of a hospital encounter for COVID-19. A propensity-match analysis was performed using baseline demographics and past medical history to compare patients with recent TBI and COVID-19 to patients with COVID-19 without recent TBI. We collected outcome measures within 1 month of COVID-19 diagnosis relating to overall mortality, intensive-care-unit (ICU) admission, and in-hospital complications. A Kaplan-Meier-survival (KMS) analysis demonstrated overall survival differences.

Results: A total of 13,970 patients were identified in each cohort. The mean age was 59 years. Compared to patients without a recent TBI, patients with a recent TBI had increased risk of hospitalization (OR 3.7 [95%-CI 3.5-4.0]; p< 0.001), intubation (OR 2.4 95%-CI 1.9-3.0; p< 0.001), ICU admission (3.7 [3.3-4.0]; p< 0.001), respiratory failure (1.5 [1.4-1.6]; p< 0.001), hepatic injury (1.7 [1.3-2.3]; p=0.001), and overall mortality (2.5 [2.2-2.8]; p< 0.001) within 1 month of COVID-19 diagnosis. Recent TBI patients had reduced risk of cardiac injury (0.8 [0.7-0.9]; p< 0.001). KMS analysis demonstrates that patients with prior TBI had increased mortality within 1 month of COVID-19 diagnosis (HR 2.5 [2.2-2.9]; p< 0.001).

Conclusion : Patients with recent TBI up to 12 months prior to a separate hospital encounter for COVID-19 diagnosis have increased risk of hospitalization, intubation, ICU admission, respiratory failure, hepatic injury, and overall mortality within 1 month of COVID-19 diagnosis. These findings indicate that clinicians caring for patients with TBI should strongly encourage prevention of COVID-19 infection to avoid these adverse complications.