Predictors of rapid progression include the following: Rapid worsening of symptoms Advanced histologic changes Older patient age Presence of edema Presence of associated autoimmune disorders Abnormalities in bilirubin, albumin, prothrombin time, or international normalized ratio (INR) The prognosis is ominous when pruritus disappears, xanthomas shrink, jaundice develops, and serum cholesterol decreases.