In a multivariable Cox regression analysis adjusted for demographic factors like age, sex, BMI, SBP, and education level, economic status, alcohol use, smoking status, MET, comorbidities (CVD, cancer, COPD), laboratory data (HbA1c, eGFR, proteinuria, serum calcium, serum albumin, CRP, and HDL-C), higher ISI quartiles were not significantly associated with a reduced risk of all-cause mortality compared to the lowest ISI quartile. Here, CRP is linked to chronic obstructive pulmonary disease.