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Early identification of children at risk is key for clinical monitoring, timely patient\u2010tailored treatment, and preventing chronic, severe sequelae. For early prediction of childhood asthma, we aimed to define an integrated risk score combining established risk factors with genome\u2010wide molecular markers at birth, complemented by subsequent clinical symptoms\/diagnoses (wheezing, atopic dermatitis, food allergy).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three longitudinal birth cohorts (PAULINA\/PAULCHEN, <jats:italic>n<\/jats:italic>\u2009=\u2009190\u2009+\u200993\u2009=\u2009283, PASTURE, <jats:italic>n<\/jats:italic>\u2009=\u20091133) were used to predict childhood asthma (age 5\u201311) including epidemiological characteristics and molecular markers: genotype, DNA methylation and mRNA expression (RNASeq\/NanoString). Apparent (ap) and optimism\u2010corrected (oc) performance (AUC\/R2) was assessed leveraging evidence from independent studies (Na\u00efve\u2010Bayes approach) combined with high\u2010dimensional logistic regression models (LASSO).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Asthma prediction with epidemiological characteristics at birth (maternal asthma, sex, farm environment) yielded an ocAUC\u2009=\u20090.65. Inclusion of molecular markers as predictors resulted in an improvement in apparent prediction performance, however, for optimism\u2010corrected performance only a moderate increase was observed (upto ocAUC\u2009=\u20090.68). The greatest discriminate power was reached by adding the first symptoms\/diagnosis (up to ocAUC\u2009=\u20090.76; increase of 0.08, <jats:italic>p<\/jats:italic>\u2009=\u2009.002). Longitudinal analysis of selected mRNA expression in PASTURE (cord blood, 1, 4.5, 6\u2009years) showed that expression at age six had the strongest association with asthma and correlation of genes getting larger over time (<jats:italic>r<\/jats:italic>\u2009=\u2009.59, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001, 4.5\u20136\u2009years).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Applying epidemiological predictors alone showed moderate predictive abilities. Molecular markers from birth modestly improved prediction. Allergic symptoms\/diagnoses enhanced the power of prediction, which is important for clinical practice and for the design of future studies with molecular markers.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cea.14475","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T04:35:52Z","timestamp":1711946152000},"page":"314-328","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["An integrated molecular risk score early in life for subsequent childhood asthma risk"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4511-7769","authenticated-orcid":false,"given":"Andreas","family":"B\u00f6ck","sequence":"first","affiliation":[{"name":"Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital University Hospital, LMU Munich  Munich Germany"},{"name":"Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich  Munich 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