Ribeiro, PedroPedroRibeiroLobo Marques, Joao AlexandreJoao AlexandreLobo MarquesPordeus, DanielDanielPordeusZacarias, LailaLailaZacariasLeite, Camila FerreiraCamila FerreiraLeiteSobreira-Neto, Manoel AlvesManoel AlvesSobreira-NetoPeixoto, Arnaldo AiresArnaldo AiresPeixotode Oliveira, AdrielAdrielde OliveiraMadeiro, Joao Paulo do ValeJoao Paulo do ValeMadeiroRodrigues, Pedro MiguelPedro MiguelRodrigues2024-04-022024-04-0220241746-8094https://dspace.usj.edu.mo/handle/123456789/522410.1016/j.bspc.2023.105558Objective: This study highlights the potential of an Electrocardiogram (ECG) as a powerful tool for early diagnosis of COVID-19 in critically ill patients with limited access to CT–Scan rooms. Methods: In this investigation, 3 categories of patient status were considered: Low, Moderate, and Severe. For each patient, 2 different body positions have been used to collect 2 ECG signals. Then, from each collected signal, 10 non-linear features (Energy, Approximate Entropy, Logarithmic Entropy, Shannon Entropy, Hurst Exponent, Lyapunov Exponent, Higuchi Fractal Dimension, Katz Fractal Dimension, Correlation Dimension and Detrended Fluctuation Analysis) were extracted every 1s ECG time-series length to serve as entries for 19 Machine learning classifiers within a leave-one-out cross-validation procedure. Four different classification scenarios were tested: Low vs. Moderate, Low vs. Severe, Moderate vs. Severe and one Multi-class comparison (All vs. All). Results: The classification report results were: (1) Low vs. Moderate - 100% of Accuracy and 100% of 𝐹1–𝑆𝑐𝑜𝑟𝑒; (2) Low vs. Severe - Accuracy of 91.67% and an 𝐹1–𝑆𝑐𝑜𝑟𝑒 of 94.92%; (3) Moderate vs. Severe- Accuracy of 94.12% and an 𝐹1–𝑆𝑐𝑜𝑟𝑒 of 96.43%; and (4) All vs All - 78.57% of Accuracy and 84.75% of 𝐹1–𝑆𝑐𝑜𝑟𝑒. Conclusion: The results indicate that the applied methodology could be considered a good tool for distinguishing COVID-19’s different severity stages using ECG signals. Significance: The findings highlight the potential of ECG as a fast and effective tool for COVID-19 examination. In comparison to previous studies using the same database, this study shows a 7.57% improvement in diagnostic accuracy for the All vs All comparison.enCOVID-19AccuracyECG signalsNon-linear analysisMachine learning classifiersF1-Scoretext::journal::journal article