Current and Potential Approaches for Defining Disease Signatures: a Systematic Review.

Identifying disease signatures in order to facilitate accurate diagnosis/treatment has been the focus of research efforts in the last decade. However, the term "disease signature" has not been properly defined, resulting in inconsistencies between studies, as well as limited ability to fully utilize the tools/information available in the evolving field of healthcare big data. Research was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. The search (in PubMed, Cochrane, and Web of Science) was limited to English articles published up to 31/12/2016. The search string was "disease signature" OR "disease signatures" OR "disease fingerprint" OR "disease fingerprints" OR "subtype signature" OR "subtype signatures" OR "subgroup signature" OR "subgroup signatures." The full text of the articles was reviewed to determine the meaning of the phrase "disease signature" as well as the context of its use. Of 285 articles identified in the search, 129 were included in the final analysis. The term disease signature was first found in an article from 2001. In the last 10 years, the use of the term increased by approximately ninefold, which is double the general increase in the number of published articles. Only one article attempted to define the term. The two major medical fields where the term was used were oncology (31%) and neurology (20%); 71% of the identified articles used a single biomarker to define the term, 13% of the articles used a pair of biomarkers, and 16% used signatures with multiple biomarker; in 42% of the identified articles, genomic biomarkers were used for the signature, in 17% measurements of biochemical compounds in body fluids, and in 10%, changes in imaging studies were used for the signature. Our findings identified a lack of consistency in defining the term disease signature. We suggest a novel hierarchical multidimensional concept for this term that would combine both current approaches for identifying diseases (one focusing on undesired effects of the disease and the other on its causes). This model can improve disease signature definition consistency which will enable to generalize and classify diseases, resulting in more precise treatments and better outcomes. Ultimately, this model could lead to developing a statistical confidence in a disease signature that would allow physicians/patients to estimate the precision of the diagnosis, which, in turn, may have important implications on patients' prognosis and treatment.